Nutrition and Food Security Assessment in Sri Lanka - 2009

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Nutrition and Food Security Assessment in Sri Lanka - 2009

ANURADHAPURA DISTRICT

Dr. Renuka Jayatissa

Dr. S.M. Moazzem Hossain

Medical Research Institute Sri Lanka

In collaboration with UNICEF and World Food Programme

September 2010

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LIST OF ABBREVIATIONS

ARI Acute Respiratory Infection BMI Body Mass Index DHS Demographic and Health Survey dl Deciliter ECCD Early Childhood Care and Development ECD Early Childhood Development FGD Focus Group Discussion GN Grama SevaNiladari GRS Growth Reference Standard HAZ Height-for-age Z score Hb Hemoglobin concentration IYCF Infant and Young Child Feeding LBW Low Birth Weight LRI Lower Respiratory Tract Infection MDG Millennium Development Goal MOH Medical Officer of Health MoHN Ministry of HealthCare and Nutrition MRI Medical Research Institute MUAC Mid Upper Arm Circumference NGO Non Government Organization ORS Oral Rehydration Solution PHI Public Health Inspector PHM Public Health Midwife RDHS Regional Director of Health Services SD Standard Deviation SL Sri Lanka UNICEF United Nations Children’s Fund URI Upper Respiratory Tract Infection WAZ Weight-for-age Z score WFP World Food Program WHO World Health Organization WHZ Weight-for-height Z score

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PREFACE

This nutrition and food security survey was carried out by the Department of Nutrition of the Medical Research Institute in collaboration with the UNICEF and the World Food Programme. This survey was focused on the maternal and child under-nutrition which remains a major public health problem in Sri Lanka, despite improvements in many health indicators. This kind of research study is more than timely to asses years of efforts taken by the government and other organizations to prevent and control undernutrition in vulnerable age groups and populations. For a population to be vibrant and work towards its progress, its constituent members have to be of sound health. Nutrition and food security plays a vital role in achieving this end. There is much room for improvements and a tremendous effort has to be made to uplift the prevailing nutritional status in the country. The nutritional status of the majority is below the satisfactory level specially among the poverty stricken people. It is a pity to see that most of them are not aware of how much nutrition contributes to the sound growth of an individual. Relationship of undernutrition to socio-economic and other factors may be used to prioritize communities to which resources should be allocated to improve the situation, and I fervently hope that the findings of this survey will be beneficial to the future policy makers in their effort to oust under nutrition and create a hale and hearty society. I appreciate the efforts taken by the staff of the medical research institute who has successfully conducted this study. I take this opportunity to thank every member of the households in which this assessment was conducted, who gave their unstinted cooperation. I am grateful to UNICEF for being interested in our welfare and investing on a very important venture of this nature. This survey will be very helpful to mitigate this problem and create a Sri Lanka free from undernutrition. Dr. Ravindra Ruberu Secretary Ministry of Health

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MESSAGE FROM UNICEF & WFP REPRESENTATIVES

The Food Security and Nutrition Survey is the first such survey in Sri Lanka to assess the nutrition situation across the country, the underlying causes of malnutrition and the related impact of the increase in global food prices. This detailed analysis of the relationship between food security and nutrition will be used to strengthen and monitor the impact of targeted interventions to mitigate malnutrition in Sri Lanka. The UN World Food Programme (WFP) and the United Nations Children’s Fund (UNICEF) are proud to be partners in this initiative. Effective joint nutrition interventions are required at all levels to achieve the first Millennium Development Goal (MDG) of halving the proportion of people who suffer from hunger and under-nutrition by 2015, and to contribute at the same time to achieving the MDGs related to child mortality, maternal health, primary education, gender equality, and HIV/AIDS. While Sri Lanka is largely on track to attaining most of the MDGs, significant challenges relating to poverty and child malnutrition remain including socio-economic and regional disparities, and the quality of public health care. While overall, with increasing wealth there has been a significant decline in the prevalence of stunting, wasting, underweight and anemia, this study reveals that there are still significant regional disparities affecting the nutritional status of the people of Sri Lanka. For example the prevalence of stunting and underweight was higher in rural areas such as the estate sector and Hambantota, while wasting was found to be higher in urban areas including Colombo. WFP and UNICEF have a 40 year long history in Sri Lanka in supporting programmes to reduce maternal and child malnutrition and micronutrient deficiencies. WFP and UNICEF will continue to work jointly to support the Government of Sri Lanka and all other relevant stakeholders to take the recommendations of this important study forward. Reza Hossaini Adnan Khan UNICEF Representative WFP Representative

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ACKNOWLEDGEMENTS

Many people have contributed to the realisation of the study and it is our desire to express our deep gratitude to all, while it is, unfortunately, impossibly to name them all. We gratefully acknowledge the continued valuable and constructive advice provided by Dr. Athula Kahadaliyanage, Former Secretary, Ministry of Healthcare and Nutrition. We also deeply acknowledge the fruitful and motivating discussions and support from the members of the National Nutrition Steering Committee and many experts, especially during the final stage of the data analysis. Special thanks go to Mr.K.Dharmawardana, Accountant, National Health Fund and his staff for their patient assistance throughout the study. Many thanks go to Dr. Lulu Raschid, Director MRI for the support. Dr. Ayesha Lokubalasuriya, Dr. Neli Rajaratna from Family Health Bureau and Dr. Senaka Thalagala, RDHS Ampara for the support extended to conduct the pilot study. Director General Census and statistics for providing census data for sample selection and providing equipment. Deep gratitude goes to the UNICEF, particularly Mr. Phillipe Duamelle, Country Representative, UNICEF, Mrs. Desiree Jongsman (Deputy country Representatives), Dr. Indra Tudawe (Monitoring and Evaluation Specialist), Mr. Adnan Khan, Country Director, WFP, Mrs. Abbes Aziz (Deputy country representative,WFP), Giancarlor (Programme coordinator,WFP) for the motivation to start and complete the study, the support to conduct the field survey. Special thanks deserve the staff of the RDHS offices, staff of the MOH officers, the District Secretaries’ Offices and Gramaseva Niradari officers. They all worked tremendously hard to complete data collection to ensure accuracy. Even when circumstances were extremely difficult, they were never tired to carry on and their passionate contribution, personal and technical, was crucial to the completion of this survey. We deeply acknowledge the villagers’, the families’, the mothers’ and the children’s willingness and openness to cooperate with us. They, patiently, answered all questions and provided valuable insights. They showed great hospitality, staying with them was always a pleasure as well as a learning experience, and we are full of respect for the way they manage their daily life.

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RESEARCH TEAM

Principal investigator Dr. Renuka Jayatissa - Consultant Medical Nutritionist, MRI

Co-investigators Dr. C.L. Piyasena - Nutritionist Dr. S.M. Moazzem Hossaine - Chief Health and Nutrition, UNICEF

Collaborative Partners Dr. Dula De Silva - Programme officer, WFP Mr. Laksiri Nanayakkara - Programme Assistant, WFP Miss Analeena - Junior Programme officer, WFP International Advisors

Prof. Abbas Bhuiya - Senior Scientist & Head, IC DDR, Bangladesh Prof. Peter Kalestron - Child Health & Nutrition Unit, Belgium

Local Advisors and Report writing Prof. Dulitha Fernando - Prof. of Community Medicine Dr. Upul Senarath - Senior Lecturer, Faculty of Medicine

Survey Manager and Field Coordinator Mr. J.M. Ranbanda - Nutrition Assistant

Survey Team Leaders Mr. H.K.T. Wijayasiri - Public Health Inspector Mr. E.C. Paranagama - Public Health Inspector Mr. P.A.K.Y. Wijesundara - Public Health Inspector

Field support Mr. S.P. Priyantha - Labourer Administrative support

Mrs. K.H.R. Shyamalee - Development Assistant Mrs. W.R.T.S. Perera - Development Assistant Miss H.I.K.N. Hevawitharana - Development Assistant Mrs. K.M.H.N. Kulathunga - Medical Laboratory Technologist Dr. Chaturangi Liyanarachchi - Pre-intern Medical Officer Dr. Nuwan Jayawardana - Pre-intern Medical Officer Dr. Supun de Silva - Pre-intern Medical Officer Mr. Piyadasa Gamage - Laboratory Ordely Mrs. P.P. Wimalamathie - Laboratory Ordely

Data Analysis Mr. Sarath Gamage (Family Health Bureau), Mr. Abdullah-Al-Harun (Save the children, Bangladesh), Mr. Mokalus Rahuman (Bangledesh), Mr. Mohammed Sadeq (Bangladesh), Mr. Mohammed Rashid (Bangladesh) Mr. Indika Siriwardana Dr. Danushka Keerthiratne - Pre-intern Medical Officer

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Enumerators B.C. Priyantha, K. Gamini, A.N.U. Kumari, J.A.C.M. Jayakody, H.M.N.P. Jayaweera, N.M.N.U. Nayakarathna, K.G.C.S. Dharmawardana, H.A.D. Rathnayaka, S.R. Asiri Sampath

Data Entry Adeesha Hewawasam, Surangi Pitigala, Samanthi kumara, Harshani Randika, Dinesh Wijayarathna, D.K. Hemali Iresha

District support staff (Gramaniladari, Samurdi Officer, Public Health Inspector, Public Health Midwife) H.M.M. Herath, H.M. Nawarathnabanda, H.G.B. Herath, P. Sarath Wijesingha, M. Bandaramanike, D.M.W.P. Dissanayaka, S.M. Hanifa, D.W. Gamini, R.M.M.B. Rajapakse, W.D. Saman Pushpakumara, J.M. Ariyadasa, W.K. Hemachandra, K.B. Wimaladasa, M. Piyadasa, H.M.R. Bandara

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KEY FINDINGS OF THE SURVEY

Nutrition status of children:

Among all children in the age group 0–59 months, 14.3 percent were stunted, 11.9 percent wasted and 18.4 percent were underweight.

24.7 percent of children in the age group 6–59 months were anaemic. The prevalence of LBW was 19.0 percent.

Nutrition status of women: Among non-pregnant women aged between 15 to 49 years, 16.9 percent were

underweight, 26.4 percent were overweight and 3.0 percent were obese. Prevalence of anaemia among pregnant women was 25.0 percent. Among lactating

women, the prevalence was 25.2 and 22.4 percent among non-pregnant women. Childhood illness:

Among the total group, 15.9 percent reported to have had symptoms related to respiratory illness and 7.2 percent had diarrhoea during the specified period in the total sample.

Dietary intake: The percentage of children yet to achieve the target of dietary diversity was 62.1 which

decreased with increasing income categories and wealth quintiles. Caring:

35.5 percent of children under 24 months had been bottle fed. Of the children aged 36-59 months, 77.8 percent had attended an early childhood

educational programme. Health services and sanitation:

All children aged 36 months and over, only 77.1 percent had been given 3 mega doses of Vitamin A.

37.0 percent of the children who had diarrhoea or respiratory symptoms had obtained services from the government sector, 60.3 percent from the private sector and 2.7 percent from other sources.

Of all pregnant mothers, 85.7 percent received iron tablets of whom 84.6 percent took them daily while 50.0 percent received Thriposaha and 100 percent women had received “poshana malla”.

Only 54.4 percent of households used both improved water source and sanitary means of excreta disposal.

Food security The percentage of households yet to achieve the target of dietary diversity was 69.1

which declined with increasing income and wealth quintiles. 53.1 percent of the households in the poorest wealth quintile have not received any food

aids. 23.5 percent of households had taken loans within the preceding month and 13.6 percent

out of that used to purchase food. 13.6 percent of households were ‘food insecure’.

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TABLE OF CONTENTS

LIST OF ABBREVIATIONS .............................................................................................................. III

PREFACE ........................................................................................................................................... IV

MESSAGE FROM UNICEF & WFP REPRESENTATIVES ............................................................. V

ACKNOWLEDGEMENTS................................................................................................................. VI

RESEARCH TEAM ........................................................................................................................... VII

KEY FINDINGS OF THE SURVEY .................................................................................................. IX

TABLE OF CONTENTS ...................................................................................................................... X

LIST OF TABLES ............................................................................................................................. XII

LIST OF FIGURES........................................................................................................................... XIV

1. METHODS ......................................................................................................................................... 3

1.1 SELECTION OF HOUSEHOLDS ............................................................................................................................. 3 1.2 COMPOSITION OF THE SURVEY TEAMS................................................................................................................. 3 1.3 THE HOUSEHOLD SURVEY ................................................................................................................................. 3 1.4 SUPERVISION AND QUALITY ASSURANCE ............................................................................................................. 4 1.5 DATA PROCESSING AND ANALYSIS ..................................................................................................................... 4

2. RESULTS ........................................................................................................................................... 5

2.1 NUTRITIONAL STATUS ...................................................................................................................................... 5 2.1.1 Nutritional status of children .................................................................................................. 5 2.1.2 Anaemia in children ................................................................................................................ 7 2.1.3 Birth weight ............................................................................................................................ 8

2.2 NUTRITIONAL STATUS OF WOMEN OF 15-49 YEARS............................................................................................... 9 2.2.1 Non pregnant women (using Body Mass Index) ....................................................................... 9 2.2.2 Nutritional status of pregnant women (using Mid Upper Arm Circumference - MUAC) .......... 10 2.2.3 Anaemia in women................................................................................................................ 10

2.3 CHILDHOOD ILLNESSES .................................................................................................................................. 12 2.3.1 Respiratory illness ................................................................................................................ 12 2.3.2 Diarrhoea............................................................................................................................. 12

2.4 DIETARY INTAKE AND FEEDING PRACTICES ........................................................................................................ 12 2.4.1 Breastfeeding practices ......................................................................................................... 12 2.4.2 Complementary feeding and bottle-feeding practices ............................................................. 12 2.4.3 Food Consumption among children in the age group 6 – 59 months ...................................... 13 2.4.4 Dietary diversity ................................................................................................................... 13 2.4.5 Individual dietary diversity score for children aged 6-59 months ........................................... 13

2.5 CARE PRACTICES .......................................................................................................................................... 13 2.5.1 Promoting early learning at household level ......................................................................... 14 2.5.2 Childhood education ............................................................................................................. 14

2.6 USE OF HEALTH SERVICES .............................................................................................................................. 14 2.6.1 Attendance at Child Welfare Clinic ....................................................................................... 14 2.6.2 Vitamin A supplementation for children ................................................................................ 14 2.6.3 Source of medical care for common childhood illnesses......................................................... 14 2.6.4 Use of services at antenatal clinics ........................................................................................ 15 2.6.5 Food and nutrient supplementation for women ...................................................................... 15 2.6.6 Samurdhi beneficiaries ......................................................................................................... 15

2.7 WATER AND SANITATION ................................................................................................................................ 15 2.7.1 Use of improved water sources ............................................................................................. 15 2.7.2 Use of sanitary means of excreta disposal ............................................................................. 16 2.7.3 Use of improved water sources and sanitary means of excreta disposal ................................. 16

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2.8 FOOD SECURITY AND COPING STRATEGIES ....................................................................................................... 16 2.8.1 Household food consumption ................................................................................................ 16 2.8.2 Household dietary diversity .................................................................................................. 17 2.8.3 Expenditure on food and other goods and services ................................................................ 17 2.8.4 Coping Strategies ................................................................................................................. 17 2.8.5 Food insecurity ..................................................................................................................... 18 2.8.5.1 Household food consumption adequacy score (HFCAS) ..................................................... 18 2.8.5.2 Food insecurity categories ................................................................................................. 18

ANNEX I .............................................................................................................................................. 19

ANNEX II ............................................................................................................................................. 52

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LIST OF TABLES

Table 1: Prevalence of malnutrition: stunting, wasting, overweight and underweight by

background characteristics ..................................................................................... 6 Table 2: Prevalence of anaemia among children 6-59 months of age by background

characteristics ........................................................................................................ 7 Table 3: Prevalence of low birth weight, and mean birth weight among children born in

the 5 years preceding the survey, by background characteristics ............................. 8 Table 4: Distribution of non-pregnant women 15-49 years by BMI levels, by background

characteristics .......................................................................................................10 Table 5: Prevalence of Anaemia*, among i) pregnant women, ii) lactating women and

iii) All non-pregnant women by background characteristics ..................................11

Table A 1: Percentage of under-5 children who reported symptoms of respiratory illness and diarrhoea by background characteristics .........................................................19

Table A 2: Infant and young child feeding practices by background characteristics.................20 Table A 3: Percentage of children aged 6-59 months, who were given different food

groups on the day preceding the interview, by background characteristics .............21 Table A 4: Individual dietary diversity score in children (IDDS) according to background

characteristics for children 6 – 59 months .............................................................22 Table A 5: Minimum meal frequency, dietary diversity, and minimum acceptable diet in

children 6-23 months, by background characteristics ............................................23 Table A 6: Participation of adult members in activities of children aged 2 to 5 years, and

percentage of under 5 children cared for by a child <10 years, by background characteristics .......................................................................................................24

Table A 7: Percentage of children aged 36-59 months who were attending an early childhood education programme, by background characteristics ...........................25

Table A: 8 Percentage of children 5-10 years of age attending Primary School, by background characteristics ....................................................................................26

Table A 9: Use of different types of play items by children under 5 years of age, according to background characteristics ................................................................27

Table A 10: Percentage of children aged 5-14 years who are involved in child labour activities, and mean hours per week, by background characteristics ......................28

Table A 11: Percentage of children less than 5 years of age who received care at child welfare clinic, by background characteristics ........................................................29

Table A 12: Percentage distribution of children who received Vitamin A mega dose supplement at 9, 18 and 36 months, by background characteristics ........................30

Table A 13: Source of care provider for children who had diarrhoea or respiratory illness during 2 weeks preceding survey, by background characteristics ..........................31

Table A 14: Percent of pregnant mothers who attended antenatal clinics, and who received “poshana malla”, “thriposha” and Iron tablets, by background characteristics .......32

Table A 15: Percentage of lactating mothers who received “thriposha” and Vitamin A by background characteristics ....................................................................................33

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Table A 16: “Samurdhi” beneficiaries” among women 15-49 years by background characteristics .......................................................................................................34

Table A 17: Distribution of households according to main source of drinking water, and households with improved source of water, by background characteristics ............35

Table A 18: Distribution of households according to drinking water treatment methods used, by background characteristics ......................................................................36

Table A 19: Distribution of household members according to type of toilet used by the household, by background characteristics .............................................................37

Table A 20: Distribution of households using both improved drinking water sources and sanitary means of excreta disposal, by background characteristics .........................37

Table A 21: Distribution of households according to duration to and from the source of drinking water, by background characteristics.......................................................38

Table A 22: Distribution of households according to the person collecting water used in the household, by background characteristics .............................................................38

Table A 23: Percentage of household members (in broad age groups) who consume three or more main meals a day, by background characteristics..........................................39

Table A 24: Proportion of households by type of foods consumed at least once in the day or night preceding the interview, by to background characteristics ............................40

Table A 25: Proportion of households by type of foods consumed in 5 days and more preceding the interview, by background characteristics .........................................41

Table A 26: Household dietary diversity score according to background characteristics............42 Table A 27: Average monthly expenditure for food, services, health, education and

productive assets, by background characteristics (add Total income as total of means) .................................................................................................................43

Table A 28: Food groups by the main and secondary sources ...................................................44 Table A 29: Current food stock duration and size compared to last year, by background

characteristics .......................................................................................................44 Table A 30: Percent of households reported food had run out at some time during the

previous 12 months, and months of adequate household food provisioning (MAHFP) by background characteristics ..............................................................45

Table A 31: Average number of times a household received food aid in the last 6 months, by background characteristics ...............................................................................46

Table A 32: Percent of households with coping strategy adopted in the previous 30 days, with its frequency .................................................................................................47

Table A 33: Food-related coping strategies adopted during the 30 days preceding the survey, by background characteristics ...................................................................48

Table A 34: Households taken loans and reasons for borrowing money, by background characteristics .......................................................................................................49

Table A 35: Household Food Consumption Adequacy Score (HFCAS) and prevalence of household food insecurity status, by background characteristics ............................50

Table A 36: Distribution of households by food security Levels ...............................................51 Table A 37: Distribution of households by food security levels by background

characteristics .......................................................................................................51

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LIST OF FIGURES Figure 1: A map showing Anuradahpura district............................................................... 01 Figure 2: Assessment of food insecurity levels......................................................... 52

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DISTRICT PROFILE – ANURADHAPURA

Anuradhapura district is one of the two districts in the North Central province of Sri Lanka. The city of Anuradhapura, the capital of the district is of great historical significance, documented in the ancient chronicles as the city from where the first King of Sri Lanka reigned. It is also of great importance to Buddhists with the venerated Sri Maha Bodhi and great stupas adorning the skyline. A map showing Anuradahpura district is given in Figure 1. Administratively, the district is divided into 19 Divisional Secretary (DS) divisions and 694 Grama Nildhari (GN) divisions. The local government institutions in the province include one Municipal Council (MC), 8 Urban Councils and 40 Pradeshiya Sabahas1.

Figure 1: A map showing Anuradahpura district 1 Department of Census and Statistics Dist rict Statistical Handbook 2007.

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The district includes a land area of approximately 7,200 sq.km. with a population of 886,359 (estimated for 2007). This is an important agricultural district in the country dominated by paddy cultivation. Of the total land area, 12.5 percent is under paddy cultivation, 38 percent under forest cover and 8 percent is covered by reservoirs. These reservoirs are of historical significance as many of them were built by ancient kings, some, over 2500 years ago. They have continued to make significant contributions to the agricultural activities of the province, over centuries. Anuradhapura can be considered as the cradle of irrigated agriculture which still shows the glories of the past. Of the employed population within the province, 62.8% are engaged in agriculture and 12.4% and 24.8% in the industrial and service sectors respectively. Health services are provided mainly by the state sector and western type of health services include 68 health care institutions with one General Hospital and 6 Base hospitals within the province. Preventive and promotive health services are provided through 19 Health Unit areas with Medical Officers of Health and field staff2. The literacy rate among males is 93.4% with that for females being 88.3%. The median income level of Rs. 16,133.00 compares well with that at national level (Rs.16,735)3. A cross sectional descriptive study was carried out to asses the nutritional status of under five children and women in the 15 – 49 year age group and their correlates.

2 Mini stry of Health, Sri Lanka, Annual Health Bulletin,2007. 3 Department of Census and Statistics, Income and Expenditure survey 2006/07.

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1. METHODS

1.1 Selection of households A sample of 617 households from the district of Anuradhapura was included in the study. The sampling frame used for selection of clusters was the most recently available population estimate – the 2001 census from the Sri Lanka Department of Census and Statistics. Clusters were defined at the level of a Grama Niladhari (GN) division. GN divisions were identified using the probability proportional to size technique. Within each cluster, 30 households were identified using a systematic sampling procedure. Map indicating the selected GN divisions is given in Figure 1. A household was defined as persons routinely sharing food from the same cooking pot and living in the same compound or physical location. Members of a household need not necessarily be relatives by blood or marriage. All selected households were included in the survey, irrespective of whether there was a child under five.

1.2 Composition of the survey teams Each survey team included three interviewers and one team leader. A Co-ordinator was recruited to take the overall responsibility for the conduct of the survey. All team leaders and team coordinators were trained by staff from Medical Research Institute (MRI) with experience from past surveys. The three interviewers from the survey team conducted all interviews. The team leader was responsible for selection of households.

1.3 The Household survey It included several components. Administration of the questionnaire: A pre tested questionnaire was administered to the head of the household. Where possible, mothers were interviewed to obtain information on child care practices and maternal nutrition. The minimum age of respondents was 15 years. Anthropometric assessments: All children aged 0 to 59 months, along with their mothers and any pregnant women in the household, were selected for measurement. All measurements were conducted by team leaders, and standardized procedures for measuring the height/length, weight were used (WHO, 1995). Anthropometric measurements were made using UNISCALES and UNICEF measuring boards. In pregnant women, Mid Upper Arm Circumference (MUAC) was measured in addition to height and weight.

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Measurement of haemoglobin levels was carried out for all individuals selected for measurements except in children less than six months of age using hemocue method, using capillary blood.

1.4 Supervision and quality assurance Constant supervision and monitoring of all field activities was attempted. Team leaders monitored the work carried out by the interviewers, while team coordinators monitored team leaders as well as the interviewers. Routine field editing of all questionnaires was conducted by the team leaders.

1.5 Data processing and analysis EPI Info 6.0 software package was used for data management and entry. Data cleaning was carried out in MS Access by sorting records to filter out extreme values and SQL queries to check logical errors. Consistency checks were run to detect and correct data entry errors. Data analysis was conducted in Anthro and SPSS. Anthro was used to calculate nutrition z-scores for women and children based on the anthropometric measurements, using WHO standards as the reference value.

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2. RESULTS A total of 601 households were included in the survey, with 7.0 percent of households being in the urban sector and 93.0 percent in the rural sector and none in the estate sector. Of the total 2,676 individuals who were usually resident in the selected households, 775 (29.0 percent) were women aged between 15.0 and 49.9 years. Children aged between 5.0 and 14.9 years was 16.1 percent and 9.5 percent were children aged less than 5 years. There were 134 children aged between 2.0-4.9 years, 5.0 percent of the total population.

2.1 Nutritional Status

2.1.1 Nutritional status of children The three indices of physical growth that describe the nutritional status of children according to WHO growth standards (WHO, 2006) are: Height-for-age, Weight-for-height and Weight-for-age. Each of the four nutritional status indicators expressed in terms of standard deviations from the median (Z-scores) of the reference population was used to assess the prevalence of stunting (height for age < -2SD), wasting (weight for height <-2SD), underweight (weight for age <-2SD) and overweight (weight for height more than +2SD). Of the 253 children under five years, 244 were included in the anthropometric assessments. As shown in Table 1, among all children in the age group 0–59 months, 14.3 percent were stunted, 11.9 percent wasted and 18.4 percent were underweight. Severe stunting was seen among 3.0 percent of the total group, with the comparable figures for severe wasting and severe underweight being 1.8 and 5.7 percent. None had weight for height values more than +2 SD. Comparisons made between sub groups are based on relatively low numbers within each such group, hence have limitations in interpretation. The prevalence of stunting was high during the first six months of life and was highest during the second year of life but does not show any consistent pattern with increasing age. Prevalence of underweight does not show any pattern related to age. The percentage of children with wasting was marginally high among females. No consistent pattern was seen in the prevalence of stunting, wasting and underweight with increasing level of maternal education, monthly household income and wealth quintiles. Prevalence of severe stunting was high in the second and fifth years of life and higher among males (4.4 percent).

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Table 1: Prevalence of malnutrition: stunting, wasting, overweight and underweight by background characteristics

Background characteristic Height-for- age

(%) Weight-for-height (%) Weight-for-age (%) Total No of

Children <-2SD <-3SD <-2SD <-3SD >+2SD <-2SD <-3SD

Age of child (months)

<6 17.9 7.7 10.8 5.4 0.0 10.5 7.9 41

6-11 4.8 0.0 18.2 0.0 0.0 9.1 0.0 24

12-23 20.4 4.1 6.1 2.0 0.0 22.4 8.2 53

24-35 10.2 0.0 14.3 0.0 0.0 18.4 4.1 51

36-47 16.1 0.0 14.3 0.0 0.0 21.4 3.6 32

48-59 11.9 4.8 11.9 2.4 0.0 23.8 7.1 43

Sex of child

Male 87.7 4.4 10.6 1.8 0.0 18.4 7.9 124

Female 83.8 1.7 13.2 1.8 0.0 18.4 3.5 120

Sector

Urban 0.0 0.0 7.7 0.0 0.0 0.0 0.0 14

Rural 15.1 3.2 12.1 1.9 0.0 19.5 6.0 230

Mother’s education

No schooling 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1

Primary 14.3 14.3 0.0 0.0 0.0 14.3 14.3 7

Secondary 18.5 6.2 10.6 1.5 0.0 22.7 4.5 69

Passed O’ Level 17.2 2.3 12.2 2.4 0.0 18.3 6.1 89

Higher 5.0 0.0 9.1 0.0 0.0 11.4 6.8 46

Monthly household income

< 9,000 13.1 3.3 14.3 1.6 0.0 20.3 6.3 67

9,000 – 13,999 24.1 10.3 3.4 0.0 0.0 20.7 6.9 30

14,000 – 19,999 11.1 4.4 6.7 2.2 0.0 15.6 8.9 47

20,000 – 31,999 17.3 0.0 14.5 2.9 0.0 20.3 4.3 77

≥ 32,000 0.0 0.0 22.2 0.0 0.0 11.1 0.0 20

Wealth index quintile

Poorest 12.1 3.0 15.6 3.1 0.0 31.3 6.3 36

Second 9.1 3.0 6.1 0.0 0.0 12.1 6.1 35

Middle 21.7 8.7 16.3 2.3 0.0 27.3 11.4 48

Fourth 17.6 2.0 16.7 3.7 0.0 18.5 7.4 56

Richest 10.3 0.0 6.2 0.0 0.0 9.2 0.0 69

Overall 14.3 3.0 11.9 1.8 0.0 18.4 5.7 244

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2.1.2 Anaemia in children The haemoglobin levels of 194 children in the age group 6–59 months were assessed using the ‘haemocue ‘method (cut off point - Hb <11.0 gms %). As shown in Table 2, the prevalence of anaemia in this group was 24.7 percent. The highest percentage was seen during the latter half of infancy (59.1 percent), and this percentage declined with increasing age, with the 48–59 months age group showing the lowest (9.5 percent). Male children showed a higher prevalence (32.0 percent) than females (17.0 percent). There was no consistent pattern in the prevalence of anaemia with increasing maternal education and indicators of income and wealth.

Table 2: Prevalence of anaemia among children 6-59 months of age by background characteristics

Background characteristic % of children with Anaemia (Hb<11.0g/dl)*

Number of Children who were investigated for Hb

Age of child (months) 6-11 59.1 22

12-23 34.0 50

24-35 20.4 49

36-47 12.9 31

48-59 9.5 42

Sex of child

Male 32.0 100

Female 17.0 94

Sector

Urban 44.4 9

Rural 23.8 185


No schooling 0.0 1

Primary 16.7 6

Secondary 26.3 57

Passed O’ Level 27.5 69

Higher 28.6 35

Monthly household income < 9,000 21.8 55

9,000 – 13,999 20.0 20

14,000 – 19,999 25.0 36

20,000 – 31,999 26.2 65

≥ 32,000 40.0 15


Poorest 17.9 28

Second 33.3 30

Middle 23.7 38

Fourth 31.8 44

Richest 18.5 54 Overall 24.7 194

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2.1.3 Birth weight Birth weights were obtained from the Child Health Development Records (CHDRs). This study included children born within the 5 years preceding the survey. Considering the newborns with a birth weight of less than 2500 grams as being low birth weight (LBW), the overall prevalence was 19.0 percent. Birth weight distribution by the current age of the child enables comparison of prevalence of LBW among different birth cohorts. There is no definite pattern observed except that the cohort aged between 0-5 months at the time of the study had the highest prevalence of LBW of 28.2 percent. Table 3: Prevalence of low birth weight, and mean birth weight among children born in the

5 years preceding the survey, by background characteristics

Background characteristic Birth Weight Number of

children < 2500g (%) ≥ 2500g (%) Mean (kg) SD


0-5 28.2 71.8 2.81 0.56 41

6-11 16.7 83.3 2.90 0.61 24

12-23 19.6 80.4 2.91 0.47 53

24-35 18.0 82.0 2.87 0.49 51

36-47 6.7 93.3 2.94 0.36 32

48-59 20.9 79.1 2.92 0.48 43

Sex of child

Male 15.7 84.3 2.93 0.52 124

Female 22.4 77.6 2.85 0.46 120

Residence

Urban 14.3 85.7 2.86 0.47 14

Rural 19.3 80.7 2.89 0.49 230


No schooling 0.0 100.0 3.11 . 1

Primary 57.1 42.9 2.63 0.50 7

Secondary 33.8 66.2 2.79 0.56 69

Passed O’ Level 12.6 87.4 2.90 0.46 89

Higher 8.7 91.3 2.97 0.47 46

Monthly household income (n=2592)

< 9,000 25.4 74.6 2.79 0.52 67

9,000 – 13,999 35.7 64.3 2.77 0.51 30

14,000 – 19,999 19.1 80.9 2.93 0.55 47

20,000 – 31,999 13.0 87.0 2.92 0.41 77

≥ 32,000 0.0 100.0 3.10 0.42 20


Poorest 33.3 66.7 2.78 0.44 36

Second 27.3 72.7 2.80 0.39 35

Middle 17.0 83.0 2.86 0.54 48

Fourth 14.5 85.5 2.90 0.54 56

Richest 13.0 87.0 3.00 0.48 69

Overall 19.0 81.0 2.89 0.49 244

9

The prevalence was higher among female newborns than males. Though based on limited numbers, it is seen that there was a decline in the prevalence with increasing levels of mother’s education and with increasing income levels and wealth quintiles. Mean birth weight for the total group was 2.89 ± 0.49 kg with no clear pattern observed between age groups. However, an upward trend was observed in relation to increasing levels of maternal education, income levels and higher wealth quintiles.

2.2 Nutritional status of women of 15-49 years

2.2.1 Non pregnant women (using Body Mass Index) A total of 205 non-pregnant women aged between 15 to 49 years, and with a child under 5 years of age were included in the assessment of body mass index. As shown in Table 4, of the total sample of non-pregnant women, 16.9 percent had BMI less than 18.5 (underweight), 26.4 percent with values between 25 and 29 (overweight ) and 3.0 percent, with BMI values of 30 or above (obese). The prevalence of underweight (BMI less than 18.5) was high in the 15 -19 age group (33.3 percent) with a substantial decline in the age groups 20-29 years (23.9 percent) and 30-39 years (8.3 percent). Of all non-pregnant women studied, 29.4 percent were either overweight or obese. This percentage was highest in the 30 – 39 age group. There was a declining pattern in the prevalence with increasing income levels even though the pattern is less consistent with higher wealth quintiles.

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Table 4: Distribution of non-pregnant women 15-49 years by BMI levels, by background characteristics

Background Characteristics

BMI category (%) Total

women Underweight (BMI<18.5)

Normal (BMI=18.5-24.9)

Overweight BMI=25.0-29.0)

Obese (BMI>30.0)

Age group (years) 15-19 33.3 55.6 11.1 0.0 10

20-29 23.9 48.9 25.0 2.2 93

30-39 8.3 56.0 31.0 4.8 86

40-49 12.5 68.8 18.8 0.0 16 Sector

Urban 9.1 54.5 36.4 0.0 11

Rural 17.4 53.7 25.8 3.2 194

Women’s education level No schooling 0.0 100.0 0.0 0.0 1

Primary 0.0 42.9 57.1 0.0 7

Secondary 25.0 45.0 23.3 6.7 62

Passed GCE (O/L) 15.1 55.8 26.7 2.3 88 Higher 13.3 60.0 26.7 0.0 45


< 9,000 22.0 48.0 30.0 0.0 51

9,000 – 13,999 11.5 65.4 19.2 3.8 26 14,000 – 19,999 16.7 57.1 23.8 2.4 43

20,000 – 31,999 13.3 53.3 28.3 5.0 61

≥ 32,000 8.3 58.3 33.3 0.0 13

Wealth index quintiles Poorest 22.2 55.6 18.5 3.7 27 Second 28.6 39.3 28.6 3.6 29

Middle 25.6 53.8 15.4 5.1 42

Fourth 10.2 59.2 28.6 2.0 49

Richest 8.6 55.2 34.5 1.7 58

Overall 16.9 53.7 26.4 3.0 205

2.2.2 Nutritional status of pregnant women (using Mid Upper Arm Circumference - MUAC) Nutritional status of 16 pregnant women was assessed using MUAC. Using this indicator, it was seen that 6.3 percent of this group were undernourished.

2.2.3 Anaemia in women Three groups of women were included in this component of the study, (i) pregnant women (16), (ii) lactating women (123), (iii) all non pregnant women including lactating women (201).

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Pregnant women As shown in Table 5, overall prevalence of anaemia among this group was 25.0 percent. Number of pregnant women in the sub groups are limited, hence no attempt is made to draw any observations on differences between sub groups. Lactating women Among lactating women, the overall prevalence was 25.2 percent. There was a consistent decline in the prevalence with increasing levels of mother’s education, even though no consistent pattern was seen with the changes in the two income related measures. All non-pregnant women The overall prevalence among this group was 22.4 percent.

Table 5: Prevalence of Anaemia*, among i) pregnant women, ii) lactating women and iii) All non-pregnant women by background characteristics

Background characteristic Pregnant Lactating All Non-pregnant

Percent Total No of Women Percent Total No of

Women Percent Total No of Women

Age group (years) < 20 0.0 66.7 6 40.0 10 20-29 12.5 8 19.7 61 17.8 90

30-39 37.5 8 26.1 46 24.7 85

40-49 0.0 30.0 10 25.0 16

Residence Urban 100.0 1 16.7 6 18.2 11

Rural 20.0 15 25.6 117 22.6 190

Women’s education level

No schooling 0.0 1 0.0 1

Primary 0.0 1 25.0 4 14.3 7 Secondary 0.0 3 25.7 35 26.2 61

Passed GCE (O/L) 42.9 7 31.4 51 24.7 85

Higher 20.0 5 13.3 30 13.3 45

Monthly household income < 9,000 20.0 5 25.9 27 28.6 49

9,000 – 13,999 0.0 1 37.5 16 36.0 25

14,000 – 19,999 33.3 3 40.0 25 26.2 42

20,000 – 31,999 40.0 5 17.5 40 16.4 61 ≥ 32,000 0.0 2 0.0 8 0.0 13

Wealth quintile of household

Poorest 0.0 1 38.9 18 34.6 26

Second 100.0 1 35.7 14 31.0 29 Middle 0.0 1 40.0 25 33.3 39

Fourth 28.6 7 9.1 33 10.2 49

Richest 16.7 6 18.2 33 15.5 58

Overall 25.0 16 25.2 123 22.4 201

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2.3 Childhood Illnesses Diarrhoea and respiratory infections are the two common illnesses that lead to increased morbidity and mortality among children under 5 years. The present study sought information from respondents related to the occurrence of these two illnesses during the two weeks preceding the interview.

2.3.1 Respiratory illness Respondents were asked whether their children less than five years of age had one or more symptoms related to respiratory illness (cough, rapid or difficult breathing) during the period of 2 weeks preceding the survey. A child who was having cough with rapid or difficult breathing, was identified as having had symptoms of respiratory illness. Among the total group, 15.9 percent reported to have had symptoms related to respiratory illness during the specified period (Table A 1).

2.3.2 Diarrhoea The respondents were asked whether their children under five years had experienced an episode of diarrhea during the two weeks preceding the survey. (Diarrhoea was defined as three or more loose or watery stools per day or blood in stool). If the child had diarrhea, information on giving oral dehydration fluid using the packet ‘Jeewani’ during the episode of diarrhoea, was inquired into. Of the total group, 7.2 percent of children reported to have had diarrhea during the specified period of whom 40 percent had been given ‘Jeevanie’.

2.4 Dietary intake and feeding practices

2.4.1 Breastfeeding practices Percentages of children less than 24 months years of age who were ever breastfed, currently breastfed and started breastfeeding within one hour / one day of birth are given in Table A 2. All children were ‘ever breastfed’. Of them, 93.8 percent were breast fed within the first hour of birth and 94.6 percent were currently breast fed, that is, given breast milk in the previous 24 hours.

2.4.2 Complementary feeding and bottle-feeding practices As shown in Table A 2, of the children aged 6-8 months 76.9 percent were given breast milk and solid / semi solid foods. In the total sample, 35.5 percent of infants under 24 months had been bottle fed.

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2.4.3 Food Consumption among children in the age group 6 – 59 months Food consumption pattern was based on the information about the food items given to children aged 6 – 59 months on the day preceding the interview. Ten different food items were included in this analysis. Table A 3 shows the percentage of children in this age group who were given the food items within the preceding 24 hours, by background characteristics. For the total sample, 95.1 percent of the children were given grains/roots/tubers, while 80 to 90 percent were given vitamin A rich fruits and vegetables, other fruits and vegetables, and meat fish/ poultry/ organ meats. Only 32 percent of children received each group, eggs and dairy products. Foods cooked with oil or fat were given to 37.95 percent of children and 37.4 percent had been given fortified food (commercially available cereals) with a much higher percentage (75.4 percent) having been given sugary foods (chocolates, sweets, candies, cakes, biscuits etc.).

2.4.4 Dietary diversity Dietary diversity is based on the premise that more diverse diets are more likely to provide adequate levels of a range of nutrients.

2.4.5 Individual dietary diversity score for children aged 6-59 months In this study, individual dietary diversity score for children aged 6 – 59 months was assessed. (according to FANTA4) . As shown in Table A 4, for all children in this age group, the IDDS was 5.0 (SD =1.7). The dietary diversity score of children aged 6-59 in the households belonging to the highest wealth quintile was used as a “target to be achieved” based on the assumption that poorer households will diversify their food consumption practices as incomes rise, and thereby attempting to follow the consumption pattern of wealthier households. Table A 4 shows that IDDS among children in the highest wealth quintile was 4.8. Based on this value, the percentage of children yet to achieve the target was assessed. This percentage was 62.1 for the total sample. The percentage decreased with increasing income categories and wealth quintiles. Information on Minimum meal frequency, minimum dietary diversity and minimum acceptable diet for children aged 6-23 months are given in Table A 5.

2.5 Care Practices Care practices were studied in relation to activities on early childhood development including promoting early learning at household level, practices related to play activities, early childhood education and school enrolment. The age group to be included in the different components in the study of care practices varied, depending on the relevance.

4 Anne Swindale & Paula Bilinsky Household Dietary Diversity Score (HDDS) for Measurement of Household Food

Access: Indicator Guide VERSION 2 September 2006

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2.5.1 Promoting early learning at household level As shown in Table A 6, the average number of’ education related activities’ undertaken by the children was 5.5. For 97.7 percent of children, an adult was engaged in more than three activities that promoted early learning, during the 3 days preceding the survey. Considering the children under 5 years of age, 11.6 percent were looked after by a child under the age of 10 years, during the week preceding the interview.

2.5.2 Childhood education As shown in Table A 7, of the children aged 36-59 months, 77.8 percent had attended an early childhood educational programme and 99.6 percent of the children who have completed 5 years by 31st January 2009 were enrolled in grade 1 and the same percentage of all children between 5-10 years of age were attending Primary School (Table A 8). Information related to play items and child labour are given in Tables A 9 and A 10 respectively.

2.6 Use of health services

2.6.1 Attendance at Child Welfare Clinic As shown in Table A 11, 97.8 percent of the children under 5 years had received care at a Child Welfare Clinic (CWC) and 89.8 percent of the children had their Child Health Development Records (CHDRs) with them at the time of interview. Of the mothers who attended the child welfare clinics, 95.0, 93.2 and 91.2 percent received advice on growth, nutrition and early childhood development respectively. Of this group, 5.9 percent of children aged 6-59 months had received at least one packet of thriposha in the previous month.

2.6.2 Vitamin A supplementation for children Of the group, 87.4 percent of children who had completed 9 months of age had received a mega dose of vitamin with the percentage of children who received a vitamin A mega dose at 18 months and 36 months being 86.8 and 78.6 percent respectively. Considering all children aged 36 months and over 77.1 percent had been given 3 mega doses of Vitamin A (Table A 12).

2.6.3 Source of medical care for common childhood illnesses Source of medical care for those children who reported diarrhoea / respiratory symptoms within the 2 weeks preceding the interview was considered under services provided by the government sector, private sector and other sectors. As shown in Table A 13, 37.0 percent of the total group used services from the government sector, 60.3 percent from the private sector and 2.7 percent from other sectors.

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2.6.4 Use of services at antenatal clinics A total of 92.9 percent of the pregnant mothers had attended antenatal clinics regularly as shown in Table A 14. Of these mothers, 85.7 percent received iron tablets of whom 84.6 percent took them daily.

2.6.5 Food and nutrient supplementation for women The two main nutrition supplementation programmes aimed at pregnant women are the provision of a food basket (“poshana malla”) through the Samurdhi programme implemented by the: Ministry of Samurdhi and Poverty Alleviation and the Thriposha programme implemented by the Ministry of Health care and Nutrition. Of all pregnant mothers, 50.0 percent received Thriposaha and all women had received “poshana malla” (Table A 14). Of the lactating mothers with a child under 6 months of age, 66.7 percent had received “thriposha” (Table A 15) and vitamin A mega dose has been given to 61.0 percent, after childbirth.

2.6.6 Samurdhi beneficiaries In the households included in the study, there were a total of 79 non pregnant, non lactating women in the age group 15 – 49 years. Of this group, 13.9 percent received Samurdhi benefits being members of households that were beneficiaries under the Samurdhi programme. (Table A 16). Percentage beneficiaries among the pregnant women and lactating women were 5.9 percent and 15.9 percent respectively.

2.7 Water and Sanitation

2.7.1 Use of improved water sources As shown in Table A 17, 60.7 percent of the households had improved sources of water. The households with piped water inside the dwelling increased with increasing wealth quintiles, from 54.5 percent in the lowest quintile to 72.8 percent in the highest quintile. A similar increase was seen as the income increases. Of the households, 58.2 percent used any one of the appropriate water treatment methods to treat their drinking water with ‘straining water through cloth’ being the most frequently used method, practiced by 39.4 percent of the households included in the study (Table A 18). The percentage of households that used boiling as a method of making water safe, increased from the lowest wealth quintile to the highest. In some households, more than one method was used.

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2.7.2 Use of sanitary means of excreta disposal Use of flush toilets connected to sewage systems, or septic tanks was considered as sanitary means of excreta disposal. As shown in Table A 19, the percentage of households using sanitary means of excreta disposal was 89.4 percent.

2.7.3 Use of improved water sources and sanitary means of excreta disposal Table A 20 shows the distribution of households that use both improved sources of drinking water and sanitary means of excreta disposal. For the district sample, 54.4 percent of households reported using both improved water source and sanitary means of excreta disposal. The percentage of households that had both facilities increased with increasing levels of income and levels of wealth quintiles. Information on the time consumed to collect water and the person collecting water are given in Tables A 21 and A 22 respectively.

2.8 Food Security and Coping Strategies

2.8.1 Household food consumption The food items consumed by households were grouped into 11 categories based on the FAO classification of food groups with some modifications to include coconut and sugar separately. These food groups were used in assessing the food consumption pattern as shown in Tables A 23 and A 24. Table A 24 provides information on food items consumed within 24 hours preceding the survey. Consumption of rice and rice products, coconuts and sugar was nearly 100 percent and consistent across all sub groups studied. Bread and wheat products were consumed by 35.6 percent of all households. Only 56.2 percent of households consumed nuts/pulses. Of all households, 85.7 percent consumed meat/ poultry/ fish or dry fish, and this percentage showed a marked increase with increasing income and wealth categories. Consumption of eggs was low, 31.2 percent. A total of 66.7 percent of households consumed fruits. An increasing trend of consumption of fruits was seen with increasing levels of income and higher wealth quintiles. The percentage of households that consumed milk and milk products was 81.5. Consumption of oils and fats were 90.8 percent and was high across most strata. Information on the consumption of different foods for at least 5 days during the week preceding the survey is shown in Table A 25. This information indicated the consistency of consumption of the foods and shows important differences from the Table A 24, which focused on the consumption pattern during the 24 hours preceding the survey.

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Similar to the 24-hour consumption pattern, rice, coconut and sugar were consumed by more than 95 percent of the households. However, the consumption of food groups such as bread and wheat products, nuts and pulses, fruits, meat/poultry/fish and dry fish, eggs, and milk/dairy products were markedly lower during the 7-day period. Table A 23 provides information on the household members who consume three or more main meals a day.

2.8.2 Household dietary diversity Household dietary diversity score (HDDS) is a proxy measure of households consuming a variety of food indicating a nutritionally ‘satisfactory’ diet and the method used to make this assessment is given in Table A 26. This table indicates that the mean HDDS for the total group was 7.7 (SD 1.5). The value shows an increasing trend with increasing income and wealth quintile. The HDDS obtained by the households in the highest wealth quintile category (8.4) was taken as the ‘target’ to be achieved and the percentage of households yet to achieve the target was calculated. For the total sample, the percentage of households yet to achieve the target was 69.1. The percentage showed a consistent decline with increasing income and wealth quintiles.

2.8.3 Expenditure on food and other goods and services Study of broad categories under which household expenditure for a one-month period showed that considering all households included in the study, 31.8 percent of the total household monthly income was spent on food, and 54.2 percent on other goods and services (Table A 27). Type of food groups by source is given in Table A 28. Food stocks, food availability at household and food aid are given in tables A 29, 30 and 31 respectively.

2.8.4 Coping Strategies During the periods when there were limitations in food availability, different coping strategies were adopted by households (Table A 32). Use of such strategies during the month preceding the survey was studied paying attention to the frequency of practice. Of the total number 20.5 percent of households had adopted one or more coping strategies. Of them, more of the households adopted food related coping strategies compared to non-food coping strategies. The common strategies adopted were: to rely on less preferred food (15.8 percent) and purchased food on credit (15.8 percent). Between 10 - 12 percent, had borrowed food or reduced meal size. The main non-food strategies adopted were: borrowing money from relatives/neighbours (10.8 percent), pawning jewellary (6.7 percent) and using savings (4.8 percent). The distribution of the households that adopted a specific food-related coping strategy by background characteristics is shown in Table A 33. However, there are limitations in drawing conclusions due to the limited number of households in the sub groups.

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Taking loans is a commonly adopted strategy to cope with difficult situations, whether it be food related or not. As shown in Table A 34, 23.5 percent of households had taken loans within the preceding month which were used for: income generation activities (29.3 percent), repairing damaged house (15.7 percent) and for purchasing food (13.6 percent).

2.8.5 Food insecurity A state of food insecurity exists when nutritionally adequate and safe foods are not readily available or there is inability to acquire acceptable foods. In this study, food insecurity levels were determined according to the method described by the World Food Programme (WFP), given in annex 2.

2.8.5.1 Household food consumption adequacy score (HFCAS) As shown in Table A 35, the mean HFCAS for all households was 63.8(SD=12.6). The scores differed between sectors, highest in the urban sector, 71.4% and lower in the rural sector, 63.2%. Study of HFCAS categories indicates that none of the households had poor food consumption, 1.8 percent were borderline and 98.2 percent, had adequate food consumption.

2.8.5.2 Food insecurity categories Food insecurity levels obtained by cross-tabulating food access categories (as indicated by percentage expenditure on food) and food consumption categories for households with a child aged less than 5 years (n= 243) are presented in Table 36. Of these households, 0.4 percent were found to be ‘severely food insecure’ with comparable percentages for ‘moderately insecure’ and ‘secure’ being 13.2 and 86.3 percent respectively. In interpreting food insecurity, the two categories, moderately and severely food insecure categories were considered together. There were no food insecure households in the urban sector. The percentage of secure households increased with increasing number of members in the household from 73.3 percent in households with 1-3 persons to 90.3 percent in those with 7 or more (Table A 37). Considering the key socio-economic indicators included in this study, the marked influences such indicators have on food insecurity is clearly shown. There was a consistent upward trend in the percentage of food secure households, with increasing levels of education of the head of the household and increasing income levels and wealth quintiles. However, these observations have to be interpreted with caution as numbers in some of such categories are small.

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ANNEX I

Table A 1: Percentage of under-5 children who reported symptoms of respiratory illness and diarrhoea by background characteristics

Background characteristic Total number of children

% reported symptoms of Total No. of children reported

Diarrhoea

% Given Jeewanee * Respiratory

illness Diarrhoea


<6 39 15.4 12.8 5.0 0.0

6-11 23 21.7 13.0 3.0 33.3

12-23 51 3.9 5.9 3.0 33.3

24-35 50 6.0 8.0 4.0 50.0

36-47 30 20.0 10.0 3.0 33.3

48-59 42 11.9 7.1 3.0 0.0

Sex of child

Male 120 12.5 8.3 10.0 20.0

Female 115 10.4 9.6 11.0 30.0

Sector

Urban 13 15.4 0.0 0.0 0.0

Rural 222 11.3 9.5 21.0 25.0


No schooling

Primary 1 0.0 0.0 0.0 0.0

Secondary 7 14.3 14.3 1.0 100.0

Passed O’ Level 65 10.8 16.9 11.0 27.3

Higher 86 11.6 7.0 6.0 16.7

Monthly household income 45 15.6 2.2 1.0 0.0

< 9,000

9,000 – 13,999 67 9.0 13.4 9.0 0.0

14,000 – 19,999 30 13.3 3.3 1.0 0.0

20,000 – 31,999 46 10.9 8.7 4.0 66.7

≥ 32,000 71 12.7 8.5 6.0 33.3

Wealth quintile 19 15.8 5.3 1.0 100.0

Poorest

Second 36 5.6 16.7 6.0 0.0

Middle 33 6.1 15.2 5.0 40.0

Fourth 44 11.4 2.3 1.0 100.0

Richest 53 13.2 7.5 4.0 0.0

Overall 69 15.9 7.2 5.0 40.0

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Table A: 2 Infant and young child feeding practices by background characteristics

Background characteristic

Percent

No. of children under 2

year Ever

breastfed Currently breastfed

Initiated breastfee

ding within

one hour of birth*

Initiated breastfee

ding within

one day of birth

Introduced complemen

tary food among

infants 6-8 months

Bottle-fed

Age of child in months

<6 100.0 100.0 94.9 94.9 0.0 14.3 41

6-11 100.0 95.5 91.3 95.7 0.0 47.8 24

12-23 100.0 90.2 94.1 100.0 0.0 44.2 53

Sex of child

Male 100.0 95.1 88.7 95.2 71.4 39.0 64

Female 100.0 94.1 100.0 100.0 83.3 31.4 54

Residence

Urban 100.0 100.0 100.0 100.0 0.0 20.0 5

Rural 100.0 94.4 93.5 97.2 76.9 36.2 113

Maternal education

No schooling 100.0 100.0 100.0 100.0 0.0 0.0 1

Primary 100.0 100.0 50.0 50.0 0.0 50.0 2

Secondary 100.0 91.4 94.4 97.2 50.0 42.9 36

Passed GCE (O/L) 100.0 97.7 93.0 97.7 80.0 34.2 43

Higher 100.0 95.0 100.0 100.0 80.0 19.0 23


< 9,000 100.0 92.3 88.5 96.2 100.0 100.0 26

9,000 – 13,999 100.0 88.2 94.1 100.0 66.7 100.0 17

14,000 – 19,999 100.0 91.7 92.0 92.0 33.3 100.0 27

20,000 – 31,999 100.0 100.0 97.2 100.0 100.0 100.0 37

≥ 32,000 100.0 100.0 100.0 100.0 100.0 100.0 9


Poorest 100.0 95.2 95.2 100.0 33.3 40.9 22

Second 100.0 91.7 100.0 100.0 0.0 41.7 12

Middle 100.0 92.6 85.7 89.3 75.0 40.0 28

Fourth 100.0 92.3 96.2 100.0 100.0 24.0 27

Richest 100.0 100.0 96.2 100.0 100.0 34.6 29

Overall 100.0 94.6 93.8 97.3 76.9 35.5 118

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Table A 3: Percentage of children aged 6-59 months, who were given different food groups on the day preceding the interview, by background characteristics


Grains/Roots/ Tubers

Legume/ Nuts

Vit A rich

fruits and

vegetables

Other fruits and

vegetables

Dairy product/

Milk / yogurt/ cheese*

Eggs

Meat/ fish/

Poultry/organ meats

Food cooked

with oil or Fat

Fortified

Food

Sugary Food


6-11 83.3 54.2 83.3 70.8 33.3 12.5 50.0 29.2 25.0 58.3

12-23 94.3 67.9 88.7 77.4 34.0 35.8 69.8 37.7 45.3 77.4

24-35 98.0 70.6 90.2 82.4 27.5 27.5 86.3 37.3 43.1 78.4

36-47 96.9 56.3 90.6 78.1 40.6 50.0 87.5 46.9 43.8 71.9

48-59 97.7 51.2 69.8 81.4 27.9 30.2 81.4 37.2 23.3 81.4

Sex of child

Male 94.3 62.9 86.7 80.0 29.5 31.4 79.0 30.5 31.4 71.4

Female 95.9 60.2 82.7 77.6 34.7 32.7 74.5 45.9 43.9 79.6

Residence

Urban 100.0 54.5 100.0 90.9 27.3 45.5 100.0 27.3 27.3 72.7

Rural 94.8 62.0 83.9 78.1 32.3 31.3 75.5 38.5 38.0 75.5

Maternal education

No schooling 100.0 100.0 100.0 100.0 100.0 0.0 0.0 100.0 0.0 100.0

Primary 100.0 83.3 100.0 66.7 50.0 16.7 100.0 33.3 83.3 83.3

Secondary 94.9 57.6 78.0 79.7 35.6 33.9 71.2 30.5 44.1 71.2

Passed GCE (O/L) 93.0 57.7 85.9 76.1 26.8 31.0 76.1 40.8 36.6 77.5

Higher 94.9 69.2 84.6 79.5 30.8 35.9 76.9 35.9 15.4 74.4


< 9,000 96.6 70.7 86.2 74.1 19.0 20.7 77.6 39.7 43.1 77.6

9,000 – 13,999 95.0 50.0 95.0 85.0 20.0 30.0 90.0 30.0 40.0 80.0

14,000 – 19,999 89.5 47.4 71.1 73.7 34.2 21.1 76.3 36.8 31.6 68.4

20,000 – 31,999 95.5 65.7 83.6 80.6 40.3 43.3 71.6 37.3 37.3 76.1

≥ 32,000 100.0 58.8 100.0 88.2 58.8 52.9 88.2 52.9 29.4 76.5


Poorest 90.3 54.8 87.1 64.5 22.6 19.4 74.2 29.0 29.0 74.2

Second 96.8 58.1 77.4 83.9 22.6 29.0 71.0 32.3 32.3 74.2

Middle 92.3 61.5 71.8 66.7 33.3 23.1 74.4 30.8 30.8 82.1

Fourth 93.5 67.4 87.0 82.6 32.6 32.6 67.4 30.4 30.4 67.4

Richest 100.0 62.5 94.6 89.3 41.1 46.4 91.1 57.1 57.1 78.6

Overall 95.1 61.6 84.7 78.8 32.0 32.0 76.8 37.9 37.4 75.4

(*Breast milk was not included)

22

Table A 4: Individual dietary diversity score in children (IDDS) according to background characteristics for children 6 – 59 months

Background characteristic IDDS (range 0-8) % of individuals yet to

achieve the target Total number of children

Mean SD


6-11 4.2 2.0 79.2 19

12-23 5.1 1.8 60.4 32

24-35 5.2 1.5 62.7 32

36-47 5.5 1.6 50.0 16

48-59 4.8 1.8 62.8 27

Sex of child

Male 4.9 1.8 64.8 68

Female 5.0 1.7 59.2 58

Residence

Urban 5.5 1.5 72.7 8

Rural 5.0 1.8 61.5 118

Maternal education

No schooling 0.0 0.0 0.0 0

Primary 5.5 1.6 50.0 3

Secondary 4.8 1.8 64.4 38

Passed GCE (O/L) 4.9 1.7 66.2 47

Higher 5.1 2.0 56.4 22


< 9,000 4.8 1.5 67.2 39

9,000 – 13,999 5.0 1.7 60.0 12

14,000 – 19,999 4.5 2.1 65.8 25

20,000 – 31,999 5.2 1.8 59.7 40

≥ 32,000 6.0 1.3 41.2 7


Poorest 4.2 2.0 74.2 23

Second 5.1 1.8 71.0 22

Middle 5.2 1.5 69.2 27

Fourth 5.5 1.6 60.9 28

Richest 4.8 1.8 46.4 26

Overall 5.0 1.7 62.1 126

23

Table A 5: Minimum meal frequency, dietary diversity, and minimum acceptable diet in children 6-23 months, by background characteristics


Minimum meal frequency Minimum Dietary

diversity score, Mean (range 0-7)

% with minimal dietary

diversity (≥4 groups)

Percentage of minimum acceptable

diet

Total no. of

children Breastfed Non- Breastfed

Age group in months

6-8 81.8 50.0 3.5 61.5 53.8 13

9-11 50.0 0.0 4.3 81.8 27.3 11

12-14 46.7 0.0 4.6 82.4 41.2 17

15-17 70.0 0.0 5.0 90.9 54.5 11

18-20 53.8 0.0 4.1 73.3 40.0 15

21-23 50.0 0.0 5.3 100.0 40.0 10

Sex of child

Male 56.4 16.7 4.5 80.0 42.2 45

Female 60.7 0.0 4.4 81.3 43.8 32

Residence

Urban 50.0 10.0 4.5 100.0 50.0 2

Rural 58.5 0.0 4.4 80.0 42.7 75

Maternal education

No schooling 100.0 0.0 5.0 100.0 100.0 1

Primary 0.0 0.0 6.0 100.0 0.0 1

Secondary 45.5 0.0 4.3 69.2 26.9 26

Passed GCE (O/L) 70.8 0.0 4.5 88.0 60.0 25

Higher 57.1 50.0 4.2 75.0 43.8 16


< 9,000 60.0 50.0 4.7 94.1 52.9 17

9,000 – 13,999 60.0 0.0 3.7 71.4 28.6 7

14,000 – 19,999 53.3 0.0 3.8 61.1 27.8 18

20,000 – 31,999 61.5 0.0 4.7 81.5 51.9 27

≥ 32,000 60.0 0.0 5.2 100.0 50.0 6


Poorest 53.3 0.0 3.9 82.4 35.3 17

Second 42.9 0.0 4.4 75.0 25.0 8

Middle 68.8 0.0 4.2 73.7 47.4 19

Fourth 50.0 33.3 4.5 82.4 41.2 17

Richest 66.7 0.0 5.2 87.5 56.3 16

Overall 58.2 10.0 4.4 80.5 42.9 77

24

Table A 6: Participation of adult members in activities of children aged 2 to 5 years, and percentage of under 5 children cared for by a child <10 years, by background

characteristics


Household adult member involved Father’s involvement

Tota

l chi

ldre

n 2

- up

to 5

ye

ars

% of children

left under the care of <10 year

old child in the past

week Tot

al C

hild

ren

unde

r 5

year

s

Mean No. of

activities

% of children with four or more activities

Mean No. of

activities

% of children with at

least one activity

Age in months

24-35 5.5 97.7 1.9 53.5 43 11.6 43

36-47 5.8 100.0 1.7 53.8 26 7.7 26

48-59 5.7 97.3 1.4 48.6 37 21.6 37

Sex of child

Male 5.6 95.9 1.6 51.0 49 8.4 83

Female 5.7 100.0 1.7 52.6 57 16.0 81

Residence

Urban 5.9 100.0 1.1 50.0 8 18.2 11

Rural 5.6 98.0 1.7 52.0 98 11.8 153

Maternal education

No schooling 0.0 0.0 0.0 0.0 0 0.0 0

Primary 3.5 100.0 0.0 0.0 3 25.0 4

Secondary 5.2 100.0 1.9 53.6 28 8.0 50

Passed GCE (O/L) 5.5 97.7 1.3 46.5 43 8.3 60

Higher 5.7 93.8 1.8 56.3 16 16.7 30


< 9,000 5.8 100.0 1.9 57.6 33 15.9 44

9,000 – 13,999 5.4 92.3 2.2 69.2 13 9.1 22

14,000 – 19,999 5.7 100.0 1.7 44.4 18 10.3 29

20,000 – 31,999 5.6 96.9 0.8 34.4 32 11.1 54

≥ 32,000 5.9 100.0 3.1 77.8 9 14.3 14


Poorest 3.8 100.0 0.9 36.4 11 16.7 18

Second 5.3 100.0 2.0 63.2 19 12.5 24

Middle 5.7 100.0 1.7 36.8 19 14.7 34

Fourth 5.6 91.7 1.4 50.0 24 13.2 38

Richest 5.6 100.0 1.9 60.6 33 8.0 50

Overall 5.5 97.7 1.9 53.5 43 11.6 43

25

Table A 7: Percentage of children aged 36-59 months who were attending an early childhood education programme, by background characteristics

Background characteristic Percent attending

Preschool or Daycare

Mean SD Total number of children

Age group in months

36-47 57.7 4.9 0.7 26

48-59 91.9 4.7 0.9 37

Sex of child

Male 75.8 4.8 0.4 33

Female 80.0 4.7 1.2 30

Residence

Urban 100.0 5.0 0.0 3

Rural 76.7 4.8 0.9 60

Maternal education

No schooling 0.0 0.0 0.0 1

Primary 95.2 0.0 0.0 21

Secondary 68.0 4.6 1.1 25

Passed GCE (O/L) 87.5 4.8 0.8 8

Higher 0.0 5.0 0.0 1


< 9,000 75.0 4.9 0.3 16

9,000 – 13,999 77.8 4.7 0.5 9

14,000 – 19,999 75.0 4.8 0.4 12

20,000 – 31,999 76.2 4.6 1.5 21

≥ 32,000 100.0 5.0 0.0 4


Poorest 75.0 4.8 0.4 8

Second 61.5 4.3 1.8 13

Middle 100.0 5.2 0.6 10

Fourth 71.4 4.8 0.4 14

Richest 83.3 4.8 0.6 18

Overall 77.8 4.8 0.9 63

26

Table A: 8 Percentage of children 5-10 years of age attending Primary School, by background characteristics


Percentage of children of primary school age currently attending Primary SchoolU

No. of children of primary school age (5-10 years)

% entered Grade 1

No. of Children Completed 5 yrs

By 31st of Jan 2009

Sex of child

Male 99.1 8 99.1 8

Female 100.0 8 100.0 8

Residence

Urban 100.0 1 100.0 1

Rural 99.6 15 99.6 15


< 9,000 100.0 1 100.0 1

9,000 – 13,999 100.0 4 100.0 4

14,000 – 19,999 100.0 3 100.0 3

20,000 – 31,999 100.0 4 100.0 4

≥ 32,000 100.0


Poorest 100.0 4 100.0 4

Second 100.0 3 100.0 3

Middle 100.0 3 100.0 3

Fourth 98.5 2 98.5 2

Richest 100.0 4 100.0 4

Overall 99.6 16 99.6 16

27

Table A 9: Use of different types of play items by children under 5 years of age, according to background characteristics


Percentage of children who play with: Total number of children <5

year Household objects

Outdoor material

Homemade toys

Ready-made toys

3 or more types of play

items Age group in months

24-35 81.0 85.7 83.3 85.7 81.4 43

36-47 73.1 73.1 96.2 88.5 76.9 26

48-59 83.8 81.1 91.9 91.9 83.8 37

Sex of child

Male 81.6 85.7 91.8 87.8 81.6 49

Female 78.6 76.8 87.5 89.3 80.7 57

Residence

Urban 87.5 75.0 87.5 75.0 87.5 8

Rural 79.4 81.4 89.7 89.7 80.6 98

Maternal education

No schooling

Primary 100.0 100.0 66.7 100.0 100.0 3

Secondary 60.7 75.0 92.9 89.3 71.4 28

Passed GCE (O/L) 86.0 86.0 88.4 93.0 83.7 43

Higher 87.5 81.3 93.8 81.3 87.5 16


< 9,000 78.1 75.0 81.3 84.4 69.7 33

9,000 – 13,999 69.2 76.9 100.0 84.6 76.9 13

14,000 – 19,999 77.8 83.3 88.9 88.9 83.3 18

20,000 – 31,999 81.3 84.4 90.6 90.6 87.5 32

≥ 32,000 100.0 88.9 100.0 100.0 100.0 9


Poorest 72.7 90.9 81.8 90.9 81.8 11

Second 78.9 84.2 94.7 94.7 78.9 19

Middle 89.5 78.9 89.5 78.9 89.5 19

Fourth 73.9 69.6 91.3 95.7 70.8 24

Richest 81.8 84.8 87.9 84.8 84.8 33

Overall 80.0 81.0 89.5 88.6 81.1 106

28

Table A 10: Percentage of children aged 5-14 years who are involved in child labour activities, and mean hours per week, by background characteristics


Working outside household in the previous week

Working outside household in the last year Total number of

children aged 5-14 year Paid

work Unpaid work

Mean hours

per week Paid work Unpaid

work

Age group in years

9-11 0.0 0.0 0.0 0.0 0.0 70

12-14 1.4 0.0 0.0 1.4 0.0 69

Sex of child

Male 0.0 0.0 0.0 0.0 0.0 83

Female 1.0 0.0 0.0 1.0 0.0 104

Residence

Urban 0.0 0.0 0.0 0.0 0.0 13

Rural 0.6 0.0 0.0 0.6 0.6 174


< 9,000 2.0 0.0 0.0 2.0 0.0 51

9,000 – 13,999 0.0 0.0 0.0 0.0 0.0 25

14,000 – 19,999 0.0 0.0 0.0 0.0 0.0 29

20,000 – 31,999 0.0 0.0 0.0 0.0 0.0 39

≥ 32,000 0.0 0.0 0.0 0.0 0.0 11


Poorest 3.4 0.0 0.0 3.4 0.0 29

Second 0.0 0.0 0.0 0.0 0.0 23

Middle 0.0 0.0 0.0 0.0 0.0 49

Fourth 0.0 0.0 0.0 0.0 0.0 56

Richest 0.0 0.0 0.0 0.0 0.0 30

Overall 0.5 0.0 0.0 0.5 0.5 187

29

Table A 11: Percentage of children less than 5 years of age who received care at child welfare clinic, by background characteristics


Availability of CHDR

Children Attended

CWC

% of children whose mothers received advice on %

Received Thriposha*

Total No. of

Children % % Growth

Nutritional

status ECCD

Age group in months

<6 90.2 91.9 93.8 90.3 86.7 0.0 14

6-11 87.5 100.0 95.5 95.5 90.9 4.2 24

12-23 94.3 100.0 96.1 96.1 92.0 5.7 53

24-35 86.3 100.0 95.7 93.6 91.1 9.8 51

36-47 93.8 100.0 93.5 93.5 93.5 3.1 32

48-59 86.0 94.7 94.7 89.5 92.1 4.7 43

Sex of child

Male 90.3 97.2 95.2 95.2 92.2 7.6 105

Female 89.2 98.3 94.8 91.3 90.4 4.1 98

Residence

Urban 92.9 83.3 90.9 90.9 88.9 0.0 11

Rural 89.6 98.6 95.2 93.3 91.3 6.3 192 Maternal education**

No schooling 100.0 100.0 100.0 100.0 100.0 0.0 1

Primary 100.0 100.0 100.0 100.0 100.0 16.7 6

Secondary 95.7 100.0 98.5 94.0 90.9 6.8 59

Passed GCE (O/L) 91.0 98.8 95.0 93.7 93.6 5.6 71

Higher 95.7 93.0 90.2 90.2 87.2 0.0 39 Monthly household income***

Up to 9000 92.5 98.4 92.1 91.9 88.7 5.2 58

9000-13999 93.3 100.0 92.9 96.4 92.6 5.0 20

14000-19999 91.5 100.0 97.7 90.7 92.9 10.5 38

20000-31999 85.7 97.1 97.1 94.1 90.9 6.0 67

32000 + 85.0 88.9 93.8 93.8 93.8 0.0 17 Wealth quintile of household

Poorest 97.2 97.0 94.3 94.3 91.4 6.5 31

Second 94.3 100.0 94.1 94.1 90.9 9.7 31

Middle 85.4 100.0 97.7 93.0 88.4 15.4 39

Fourth 87.5 96.2 91.7 89.6 87.2 2.2 46

Richest 88.4 96.7 96.7 95.0 96.6 0.0 56

Overall 89.8 97.8 95.0 93.2 91.2 5.9 203

30

Table A 12: Percentage distribution of children who received Vitamin A mega dose supplement at 9, 18 and 36 months, by background characteristics


Children 9-59 months

Children 18-59 months Children 36-59months Of the

children 36-59,

percentage never

received Vit A.

Number of

children

% received Vit A at

9 months

Number of

children

% received Vit A at

18 months

Number of

children

% received Vit A at

36 month

% received 3 doses of Vit A

Sex of child Male 93 88.2 68 89.7 36 86.1 86.1 8.3

Female 90 86.7 76 84.2 34 70.6 67.6 3.1

Residence

Urban 10 100.0 8 100.0 3 100.0 100.0 0.0

Rural 173 86.7 136 86.0 67 77.6 76.1 6.2 Maternal education

No schooling 1 100.0 5 100.0 0 0.0 0.0 0.0

Primary 6 100.0 41 90.2 2 100.0 100.0 0.0

Secondary 56 85.7 48 79.2 22 86.4 81.8 4.5

Passed GCE (O/L) 63 82.5 28 92.9 24 75.0 75.0 4.5

Higher 34 94.1 1 0.0 12 83.3 83.3 7.7 Monthly household income

Up to 9000 53 90.6 45 86.7 20 75.0 75.0 15.0

9000-13999 17 94.1 15 93.3 9 77.8 77.8 12.5

14000-19999 34 79.4 25 84.0 12 75.0 75.0 0.0

20000-31999 60 85.0 44 86.4 24 87.5 83.3 0.0

32000 + 16 93.8 12 83.3 4 50.0 50.0 0.0 Wealth quintile of household

Poorest 27 88.9 20 85.0 8 87.5 87.5 12.5

Second 31 83.9 26 80.8 16 68.8 62.5 14.3

Middle 33 84.8 26 80.8 10 70.0 70.0 0.0

Fourth 42 78.6 32 87.5 16 75.0 75.0 6.3

Richest 50 98.0 40 95.0 20 90.0 90.0 0.0

Overall 183 87.4 144 86.8 70 78.6 77.1 5.9

31

Table A 13: Source of care provider for children who had diarrhoea or respiratory illness during 2 weeks preceding survey, by background characteristics

Background characteristic Source of provider (%) Number of children

who had diarrhoea or respiratory illness in

previous 2 weeks Gov.

sector Private sector Other


<6 25.0 75.0 0.0 14

6-11 50.0 50.0 0.0 9

12-23 29.4 58.8 11.8 18

24-35 44.4 55.6 0.0 12

36-47 27.3 72.7 0.0 14

48-59 50.0 50.0 0.0 18

Sex of child

Male 32.5 65.0 2.5 48

Female 42.4 54.5 3.0 37

Residence

Urban 20.0 80.0 0.0 5

Rural 38.2 58.8 2.9 80

Estate 0.0 0.0 0.0 5


No schooling 100.0 0.0 0.0 3

Primary 40.0 60.0 0.0 30

Secondary 45.5 45.5 9.1 26

Passed O’ Level 20.0 80.0 0.0 15

Higher 100.0 0.0 0.0 3


Up to 9000 78.9 21.1 0.0 24

9000-13999 28.6 71.4 0.0 7

14000-19999 37.5 50.0 12.5 18

20000-31999 16.0 84.0 0.0 30

32000 + 0.0 100.0 0.0 6


Poorest 70.0 20.0 10.0 13

Second 66.7 33.3 0.0 11

Middle 50.0 50.0 0.0 13

Fourth 26.7 66.7 6.7 19

Richest 14.8 85.2 0.0 29

Overall 37.0 60.3 2.7 85

32

Table A 14: Percent of pregnant mothers who attended antenatal clinics, and who received “poshana malla”, “thriposha” and Iron tablets, by background characteristics


Regular ANC Visits*

“poshana malla”, “thriposha” Iron tablets Total

No. of Pregna

nt women

Percent

Total No of Mothe

rs

Percent

Total No of

Mothers

Percent

Total No of

Mothers

Percent received tablets

Of the received, percent

took daily

Total No of

Mothers

Residence Urban 100.0 1 100.0 2 0.0 2 100.0 100.0 1 2

Rural 92.3 13 100.0 12 58.3 12 84.6 83.3 13 15 Maternal education

No schooling 0.0 0 0.0 0 0.0 0 0.0 0.0 0 0

Primary 100.0 1 100.0 1 0.0 1 100.0 100.0 1 1

Secondary 100.0 2 100.0 1 100.0 1 100.0 100.0 2 3 Passed GCE (O/L) 100.0 6 100.0 6 50.0 6 83.3 83.3 6 7

Higher 80.0 5 100.0 6 50.0 6 80.0 75.0 5 6 Monthly household income

Up to 9000 100.0 5 100.0 5 40.0 5 80.0 80.0 5 5

9000-13999 100.0 1 100.0 1 100.0 1 100.0 100.0 1 1

14000-19999 100.0 3 100.0 2 50.0 2 100.0 100.0 3 3

20000-31999 100.0 3 100.0 3 66.7 3 100.0 100.0 3 5

32000 + 50.0 2 100.0 3 33.3 3 50.0 0.0 2 3 Wealth quintile of household

Poorest 100.0 1 100.0 1 100.0 1 100.0 100.0 1 1

Second 100.0 1 100.0 1 0.0 1 0.0 100.0 1 1

Middle 100.0 1 100.0 1 0.0 1 100.0 100.0 1 1

Fourth 100.0 6 100.0 5 40.0 5 100.0 83.3 6 7

Richest 80.0 5 100.0 6 66.7 6 80.0 75.0 5 7

Overall 92.9 14 100.0 14 50.0 14 85.7 84.6 14 17

*(First visits were excluded)

33

Table A 15: Percentage of lactating mothers who received “thriposha” and Vitamin A by background characteristics


“thriposha” (child <6 months)

Vitamin A mega dose (child <24 months)

Percent Total No of Women

Percent

Total No of Women

Sector

Urban 66.7 3 50.0 4

Rural 66.7 30 61.8 55

Maternal education

No schooling 0.0 0 0.0 0

Primary 100.0 1 0.0 1

Secondary 66.7 9 64.3 14

Passed GCE (O/L) 68.8 16 57.1 28

Higher 66.7 6 73.3 15


Up to 9000 75.0 8 46.2 13

9000-13999 60.0 10 71.4 14

14000-19999 62.5 8 73.3 15

20000-31999 83.3 6 38.5 13

32000 + 0.0 1 100.0 4


Poorest 75.0 4 66.7 12

Second 75.0 4 50.0 6

Middle 66.7 9 76.9 13

Fourth 57.1 7 57.1 14

Richest 66.7 9 50.0 14

Overall 66.7 33 61.0 59

34

Table A 16: “Samurdhi” beneficiaries” among women 15-49 years by background characteristics


Pregnant Lactating Non-pregnant & non- lactating

Percent Total No

of Women

Percent Total No

of Women

Percent Total No

of Women

Residence Urban 0.0 2 0.0 6 20.0 5

Rural 6.7 15 16.7 120 13.5 74

Maternal education

No schooling 0.0 0 0.0 0 0.0 0

Primary 0.0 1 100.0 1 0.0 3

Secondary 33.3 3 50.0 4 11.5 26

Passed GCE (O/L) 0.0 7 16.7 36 17.1 35

Higher 0.0 6 11.3 53 13.3 15 Monthly household income

Up to 9000 20.0 5 39.3 28 13.0 23

9000-13999 0.0 1 23.5 17 0.0 9

14000-19999 0.0 3 7.7 26 17.6 17

20000-31999 0.0 5 2.5 40 19.0 21

32000 + 0.0 3 12.5 8 20.0 5 Wealth quintile of household

Poorest 100.0 1 36.8 19 0.0 8

Second 0.0 1 7.1 14 6.7 15

Middle 0.0 1 14.8 27 26.7 15

Fourth 0.0 7 18.2 33 12.5 16

Richest 0.0 7 6.1 33 16.0 25

Overall 5.9 17 15.9 126 13.9 79

35

Table A 17: Distribution of households according to main source of drinking water, and households with improved source of water, by background characteristics


Main source of drinking water

Improved source of drinking water*

Improved sources

Uni

mpr

oved

so

urce

s

Pipe

d in

to

dwel

ling

Pipe

d in

to

yard

or

plot

Publ

ic ta

p /s

tand

pipe

Tube

wel

l/ bo

reho

le

Prot

ecte

d w

ell

Prot

ecte

d sp

ring

Rai

nwat

er

colle

ctio

n

Bot

tled

wat

er

Sector

Urban 54.8 19.0 14.3 2.4 2.4 0.0 0.0 7.1 0.0 100.0

Rural 5.0 11.4 4.8 3.8 29.9 2.5 0.4 0.0 42.2 57.8

Income group

< 9,000 6.3 12.6 3.7 4.2 25.8 1.6 0.5 0.0 45.3 54.7

9,000 -13,999 7.4 14.8 4.9 3.7 27.2 2.5 1.2 0.0 38.3 61.7

14,000 – 19,999 1.9 10.4 6.6 0.9 32.1 1.9 0.0 0.9 45.3 54.7

20,000 – 31,999 11.6 11.6 4.1 4.1 29.5 4.1 0.0 0.7 34.2 65.8

≥ 32,000 23.3 6.7 15.0 3.3 25.0 0.0 0.0 1.7 25.0 75.0

Wealth index quintiles

Poorest 3.0 12.1 3.0 3.0 31.3 1.0 0.0 1.0 45.5 54.5

Second 3.0 19.0 8.0 6.0 24.0 0.0 0.0 0.0 40.0 60.0

Middle 4.1 11.4 4.9 1.6 32.5 2.4 0.8 0.0 42.3 57.7

Fourth 7.7 10.5 6.3 4.2 24.5 2.1 0.7 0.7 43.4 56.6

Richest 21.3 8.8 5.1 3.7 27.9 5.1 0.0 0.7 27.2 72.8

Overall 8.5 12.0 5.5 3.7 28.0 2.3 0.3 0.5 39.3 60.7

36

Table A 18: Distribution of households according to drinking water treatment methods used, by background characteristics


Water treatment method used in the household

Appropriate water

treatment method *

Total No of household

Non

e

Boi

l

Add

bl

each

/chl

orin

e

Stra

in th

roug

h a

clot

h

Use

wat

er fi

lter

Sola

r di

sinf

ectio

n

Let

it s

tand

and

se

ttle

Oth

er

Sector

Urban 9.5 66.7 11.9 23.8 38.1 2.4 0.0 0.0 78.6 42

Rural 15.0 30.9 2.9 40.6 29.2 0.7 2.3 0.9 56.7 559

Wealth index quintiles

Poorest 24.2 25.3 0.0 45.5 15.2 0.0 2.0 0.0 39.4 99

Second 15.0 27.0 2.0 41.0 26.0 1.0 1.0 2.0 54.0 100

Middle 13.0 28.5 4.1 44.7 30.9 1.6 1.6 0.8 56.9 123

Fourth 13.3 33.6 4.9 37.1 32.9 0.7 2.8 0.7 60.1 143

Richest 10.3 48.5 5.1 31.6 39.0 0.7 2.9 0.7 74.3 136

Income group

< 9,000 18.9 30.5 1.6 43.7 23.7 1.6 2.1 1.1 51.1 190

9,000 – 13,999 13.6 30.9 2.5 38.3 27.2 0.0 2.5 1.2 55.6 81

14,000 – 19,999 13.2 31.1 3.8 38.7 30.2 0.9 2.8 0.9 60.4 106

20,000 – 31,999 13.0 34.9 4.1 37.7 34.9 0.0 2.1 0.0 63.0 146

≥ 32,000 11.7 50.0 10.0 26.7 41.7 1.7 1.7 1.7 73.3 60

Overall 14.6 33.4 3.5 39.4 29.8 0.8 2.2 0.8 58.2 601

37

Table A 19: Distribution of household members according to type of toilet used by the household, by background characteristics


Type of toilet facility used by household Percentage of population using sanitary means of excreta disposal *

Number of households

Flush Pit Temporary No toilet Missing

Sector Urban 90.5 7.1 0.0 0.0 2.4 90.5 42 Rural 89.3 3.6 3.4 2.3 1.4 89.3 559 Wealth index quintiles Poorest 55.6 13.1 18.2 12.1 1.0 55.6 99 Second 90.0 4.0 1.0 1.0 4.0 90.0 100 Middle 95.1 3.3 0.0 0.0 1.6 95.1 123

Fourth 97.9 1.4 0.0 0.0 0.7 97.9 143

Richest 99.3 0.0 0.0 0.0 0.7 99.3 136 Income group

< 9,000 85.3 2.1 6.8 4.2 1.6 85.3 190

9,000 – 13,999 88.9 6.2 1.2 1.2 2.5 88.9 81

14,000 – 19,999 89.6 5.7 1.9 1.9 0.9 89.6 106

20,000 – 31,999 95.2 2.7 0.7 1.4 0.0 95.2 146

≥ 32,000 90.0 5.0 0.0 0.0 5.0 90.0 60

Overall 89.4 3.8 3.2 2.2 1.5 89.4 601

Table A 20: Distribution of households using both improved drinking water sources and

sanitary means of excreta disposal, by background characteristics


Percentage of household

population using improved sources

of drinking water *

Percentage of household

population using sanitary means of

excreta disposal **

Percentage of household population using improved sources of drinking water and using sanitary means

of excreta disposal

Number of household

Sector Urban 100.0 90.5 90.5 42 Rural 57.8 89.3 51.7 559 Wealth index quintiles Poorest 54.5 55.6 29.3 99 Second 60.0 90.0 54.0 100 Middle 57.7 95.1 54.5 123 Fourth 56.6 97.9 55.2 143 Richest 72.8 99.3 72.1 136 Income group

< 9,000 54.7 85.3 47.4 190

9,000 – 13,999 61.7 88.9 53.1 81

14,000 – 19,999 54.7 89.6 48.1 106

20,000 – 31,999 65.8 95.2 64.4 146

≥ 32,000 75.0 90.0 66.7 60

Overall 60.7 89.4 54.4 601

38

Table A 21: Distribution of households according to duration to and from the source of drinking water, by background characteristics


Time to source of drinking water Mean time to source of drinking water (excluding

those on premises)

Number of households Water on

premises

Less than 15

minutes

15 minutes to less than 30 minutes

More than 30 minutes

Sector Urban 73.8 4.8 0.0 0.0 4.6 42 Rural 16.5 52.4 11.4 6.6 10.0 559 Wealth index quintiles Poorest 15.2 58.6 15.2 9.1 16.2 99 Second 22.0 55.0 11.0 7.0 8.6 100 Middle 15.4 56.9 14.6 3.3 9.8 123 Fourth 18.2 47.6 9.8 5.6 8.9 143 Richest 30.1 32.4 4.4 6.6 8.6 136 Income group

< 9,000 18.9 54.7 16.3 6.3 10.7 190

9,000 – 13,999 22.2 45.7 8.6 9.9 11.5 81

14,000 – 19,999 12.3 57.5 8.5 4.7 8.2 106

20,000 – 31,999 23.3 45.2 10.3 3.4 8.7 146

≥ 32,000 30.0 30.0 1.7 8.3 11.3 60 Overall 20.5 49.1 10.6 6.2 10.1 601

Table A 22: Distribution of households according to the person collecting water used in the

household, by background characteristics


Person collecting drinking water Number of households Adult

man Adult

woman Male child (under 15)

Female child (under 15) Other

Sector

Urban 20.0 60.0 0.0 0.0 20.0 42 Rural 16.8 81.0 0.5 0.5 1.2 559 Wealth index quintiles Poorest 19.0 78.6 0.0 1.2 1.2 99

Second 17.9 79.5 0.0 1.3 1.3 100 Middle 13.8 85.1 0.0 0.0 1.1 123

Fourth 18.0 80.9 1.1 0.0 0.0 143

Richest 15.4 78.5 1.5 0.0 4.6 136 Income group

< 9,000 16.3 82.4 0.0 0.7 0.7 190

9,000 – 13,999 20.4 79.6 0.0 0.0 0.0 81

14,000 – 19,999 12.8 84.6 1.3 0.0 1.3 106

20,000 – 31,999 14.6 83.1 1.1 0.0 1.1 146

≥ 32,000 17.4 69.6 0.0 0.0 13.0 60 Overall 16.8 80.7 0.5 0.5 1.5 601

39

Table A 23: Percentage of household members (in broad age groups) who consume three or more main meals a day, by background characteristics

Background Characteristic 5-17 years 18-59 years 60 years or

above

Male Female Male Female Male Female

No. of members in family

1-3 90.3 100.0 98.4 95.4 88.9 86.4

4-6 98.8 97.4 98.9 99.0 89.2 93.4

≥ 7 100.0 96.2 97.6 97.6 85.7 84.6

Sector

Urban 100.0 100.0 100.0 100.0 100.0 93.3

Rural 97.6 97.4 98.6 97.9 86.2 89.3

Monthly household income (LKR)

< 9,000 94.8 97.4 98.1 95.3 84.6 82.1

9,000 – 13,999 100.0 100.0 100.0 100.0 100.0 100.0

14,000 – 19,999 97.3 94.4 97.1 98.0 83.3 87.5

20,000 – 31,999 100.0 100.0 99.3 99.3 83.3 92.6

≥ 32,000 100.0 95.2 100.0 100.0 100.0 94.1

Wealth quintile

Poorest 90.6 96.9 96.2 91.6 83.3 80.0

Second 97.0 100.0 98.8 98.9 83.3 81.8

Middle 97.9 98.4 99.1 100.0 90.0 94.4

Fourth 100.0 96.6 98.5 97.8 81.8 93.5

Richest 100.0 96.3 100.0 100.0 100.0 96.3

Overall 97.7 97.6 98.7 98.0 88.5 89.8

40

Table A 24: Proportion of households by type of foods consumed at least once in the day or night preceding the interview, by to background characteristics

Background Characteristic

Food Groups

Rice Wheat Nuts/ pulses

Vegetables Fruits

Meat/ poultry/ fish

Eggs

Milk/ diary produ

cts

Oils/ fats

Coconut Sugar


1-3 99.4 33.3 54.5 87.2 64.6 78.8 26.5 77.6 82.5 98.8 100.0

4-6 100.0 35.8 54.5 89.1 67.7 87.8 30.3 82.5 93.8 99.5 99.5

≥ 7 100.0 41.7 76.7 92.9 65.0 93.0 50.0 84.8 95.3 100.0 100.0

Sector

Urban 100.0 44.8 78.0 100.0 81.0 92.9 40.7 97.5 87.8 100.0 100.0

Rural 99.8 34.7 54.5 88.0 65.5 85.2 30.5 79.8 91.1 99.3 99.6 Religion of the HH Head

Budddhist 99.8 29.4 57.9 88.5 67.2 85.8 30.7 80.6 91.0 99.3 99.8

Hindu 100.0 0.0 0.0 100.0 50.0 0.0 0.0 0.0 100.0 100.0 100.0

Islam 100.0 87.9 41.2 91.2 58.1 88.6 39.1 96.0 88.6 100.0 97.1

Catholic 100.0 0.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Monthly household income

< 9,000 99.5 35.8 52.6 86.0 56.0 80.0 25.2 72.1 85.9 99.5 99.5

9,000 – 13,999 100.0 24.3 60.0 90.1 63.6 87.7 25.0 76.0 88.8 98.8 98.8

14,000 – 19,999 100.0 38.8 52.0 92.3 72.2 84.6 32.5 78.0 92.3 100.0 100.0

20,000 – 31,999 100.0 33.7 54.7 86.8 75.7 91.1 33.0 88.7 95.1 99.3 100.0

≥ 32,000 100.0 41.7 70.7 93.2 74.5 94.9 52.4 100.0 98.3 100.0 100.0

Wealth quintile

Poorest 100.0 33.9 55.7 90.6 53.4 67.4 24.2 58.8 84.9 99.0 100.0

Second 100.0 30.2 53.3 85.4 57.8 81.4 26.6 76.9 89.8 98.0 98.0

Middle 99.2 36.9 53.2 88.5 64.0 85.2 29.5 84.6 87.6 99.2 100.0

Fourth 100.0 40.3 61.8 83.8 76.0 90.1 28.7 85.5 95.1 100.0 100.0

Richest 100.0 35.1 55.2 95.6 74.2 97.0 41.7 87.5 94.1 100.0 100.0

Overall 99.8 35.6 56.2 88.9 66.7 85.7 31.2 81.5 90.8 99.3 99.7

Total No. 601 323 557 592 546 588 417 411 589 601 599

41

Table A 25: Proportion of households by type of foods consumed in 5 days and more preceding the interview, by background characteristics


Food Groups

Rice Wheat Nuts/ pulses

Vegetables Fruits

Meat/ poultry/ fish

Eggs

Milk/ diary produ

cts

Oils/ fats

Coconut Sugar


1-3 97.0 6.5 11.2 73.4 20.7 50.9 4.7 45.0 56.2 91.7 91.1

4-6 98.2 4.9 13.1 80.2 30.1 56.8 5.1 54.5 84.1 98.5 95.9

≥ 7 100.0 4.7 18.6 79.1 39.5 51.2 11.6 62.8 90.7 97.7 93.0

Sector

Urban 97.6 14.3 40.5 90.5 42.9 59.5 4.8 92.9 81.0 100.0 100.0

Rural 98.0 4.7 10.9 77.3 27.0 54.4 5.5 49.4 76.4 96.2 93.9 Religion of the HH Head

Budddhist 98.2 3.1 13.4 79.4 29.1 56.3 5.6 52.2 76.7 96.6 94.0

Hindu 100.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 100.0

Islam 94.3 40.0 5.7 60.0 8.6 28.6 5.7 54.3 80.0 94.3 97.1

Catholic 100.0 50.0 0.0 100.0 50.0 0.0 0.0 100.0 100.0 100.0 100.0

Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Monthly household income

< 9,000 95.8 4.2 7.4 70.5 16.8 45.8 4.2 35.3 68.4 93.7 91.6

9,000 – 13,999 98.8 1.2 8.6 84.0 27.2 54.3 3.7 42.0 76.5 97.5 95.1

14,000 – 19,999 98.1 8.5 10.4 79.2 31.1 52.8 7.5 59.4 76.4 97.2 93.4

20,000 – 31,999 99.3 4.1 17.8 82.2 31.5 63.0 6.2 65.8 84.2 97.9 95.9

≥ 32,000 100.0 10.0 30.0 80.0 50.0 70.0 8.3 80.0 93.3 100.0 98.3

Wealth quintile

Poorest 97.0 6.1 7.1 76.8 21.2 35.4 4.0 28.3 65.7 89.9 86.9

Second 98.0 4.0 11.0 73.0 19.0 50.0 4.0 33.0 72.0 97.0 93.0

Middle 96.7 4.9 4.9 75.6 28.5 56.9 8.1 49.6 74.8 95.1 96.7

Fourth 98.6 6.3 19.6 76.2 24.5 53.1 3.5 64.3 81.8 98.6 97.2

Richest 99.3 5.1 19.1 87.5 43.4 72.1 7.4 74.3 84.6 100.0 95.6

Overall 98.0 5.3 13.0 78.2 28.1 54.7 5.5 52.4 76.7 96.5 94.3

42

Table A 26: Household dietary diversity score according to background characteristics


Household diversity score % of households yet to

achieve the target No of households

Mean SD

No. of members in Household

1-3 7.2 1.5 81.1 169

4-6 7.8 1.4 65.8 389

≥ 7 8.5 1.5 51.2 43

Sector

Urban 8.9 1.2 33.3 42

Rural 7.6 1.5 71.7 559

Religion of the HH Head

Budddhist 7.6 1.5 70.4 554

Hindu 4.5 0.7 100.0 2

Islam 8.3 1.6 48.6 35

Catholic 9.5 0.7 0.0 2

Other


< 9,000 7.1 1.5 81.6 190

9,000 – 13,999 7.5 1.3 77.8 81

14,000 – 19,999 7.8 1.3 67.0 106

20,000 – 31,999 8.0 1.4 58.9 146

≥ 32,000 8.6 1.4 45.0 60

Wealth quintile

Poorest 6.9 1.5 87.9 99

Second 7.1 1.5 80.0 100

Middle 7.6 1.5 74.8 123

Fourth 8.0 1.3 60.8 143

Richest 8.4 1.3 50.7 136

Overall 7.7 1.5 69.1 601

43

Table A 27: Average monthly expenditure for food, services, health, education and productive assets, by background characteristics (add Total income as total of means)


Average monthly expenditure in LKR Number of households Food Liquor/

tobacco Utility

services Health Educa

tion

Productive

assets Total


1-3 43.0 7.2 10.5 3.6 1.1 34.6 17564 30

4-6 35.0 2.4 7.3 2.5 2.2 50.5 30109 166

≥ 7 20.6 2.1 4.4 1.4 1.6 70.0 62287 31

Residence

Urban 8.7 0.2 3.9 0.9 1.1 85.2 146652 14

Rural 35.5 3.2 6.9 2.4 2.2 49.8 29064 213

Religion of household Head

Buddhist 34.5 3.2 7.3 2.5 2.3 50.3 30105 209

Hindu 91.5 0.0 6.0 2.6 0.0 0.0 10911 1

Islam 53.3 0.9 10.0 4.0 3.7 28.2 22165 13

Catholic and other Christian 14.2 0.0 8.1 2.0 0.0 75.7 84377 2

Education of household Head

No schooling 87.2 0.0 4.3 2.9 5.6 0.0 12865 3

Primary 38.7 0.4 7.7 3.0 3.3 47.0 25654 26

Secondary 28.6 2.1 5.3 2.0 1.6 60.4 35221 80

Passed O’ Level 31.3 3.7 7.6 2.3 2.2 52.8 34784 104

Higher 76.8 0.0 21.2 2.0 0.0 0.0 12414 2


< 9,000 52.5 5.1 8.6 3.1 2.4 28.3 18131 63

9,000 – 13,999 67.8 6.5 12.7 5.4 4.6 3.0 13680 27

14,000 – 19,999 36.3 1.0 7.2 2.4 1.9 51.2 26389 45

20,000 – 31,999 39.3 3.7 8.8 3.1 3.2 41.9 28342 69

≥ 32,000 21.1 2.7 7.2 1.8 1.7 65.6 70765 19

Wealth quintile

Poorest 61.4 3.3 8.4 3.9 2.9 20.0 13735 42

Second 56.6 6.0 9.6 3.3 2.7 21.9 15989 25

Middle 64.8 5.4 11.8 3.3 3.8 11.0 16212 45

Fourth 21.6 1.3 4.6 1.7 1.7 69.1 51178 47

Richest 29.5 3.0 8.0 2.5 2.1 54.8 39980 68

Overall 31.8 2.7 6.8 2.3 2.1 54.2 32844 227

44

Table A 28: Food groups by the main and secondary sources


Food Groups

Rice Wheat Nuts/pulses

Vegetables

Fruits

Meat/ poult

ry Fish Eggs

Milk/diary products

Oils/ fats

Coconut

Sugar

Main source

Own production 56.1 2.2 8.6 46.7 49.3 0.7 1.5 6.7 3.7 13.2 37.2 1.5

Purchase 42.8 96.8 88.0 50.4 45.4 96.0 96.3 88.2 91.9 84.7 59.2 93.5

Purchase on credit 0.3 0.3 0.7 0.5 0.4 0.3 0.2 0.2 0.2 0.3 0.3 1.0 Traded goods or services 0.0 0.0 0.0 0.0 0.5 0.3 0.0 0.0 0.0 0.0 0.0 0.0

Borrowed 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Gift from family or relatives 0.7 0.3 0.7 1.2 2.6 0.7 0.5 0.7 0.2 0.2 1.7 0.0

Food aid 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Cash assistance 0.0 0.0 0.2 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.5

Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Table A 29: Current food stock duration and size compared to last year, by background

characteristics

Background characteristic Size of food stock compared to last year Mean No. of

days current food stock last

No. of households More (%) Same (%) Less (%) Much less (%)

No. of members in family 1-3 8.0 49.4 37.7 4.9 6.37 162 4-6 24.7 41.5 30.7 3.1 6.33 381

≥ 7 29.3 34.1 36.6 0.0 5.33 41

Sector

Urban 19.0 66.7 14.3 0.0 7.88 42

Rural 20.5 41.3 34.5 3.7 6.15 542


No schooling 11.8 47.1 29.4 11.8 4.05 17

Primary 19.7 37.8 40.9 1.6 6.28 127

Secondary 15.1 39.6 39.6 5.7 5.94 212

Passed O’ Level 25.3 51.1 22.1 1.6 6.51 190

Higher 18.2 72.7 9.1 0.0 7.17 11


< 9,000 11.5 39.6 44.5 4.4 4.46 182

9,000 – 13,999 16.0 51.9 28.4 3.7 6.51 81

14,000 – 19,999 18.6 40.2 35.3 5.9 6.40 102

20,000 – 31,999 32.9 40.4 24.7 2.1 6.99 146

≥ 32,000 26.3 50.9 22.8 0.0 8.81 57

Wealth quintile

Poorest 13.3 35.7 43.9 7.1 4.22 98

Second 13.5 37.5 45.8 3.1 5.65 96

Middle 23.5 42.9 29.4 4.2 7.02 119

Fourth 14.0 50.0 33.8 2.2 6.19 136

Richest 34.1 45.9 18.5 1.5 7.58 135

Overall 20.4 43.2 33.0 3.4 6.27 584

45

Table A 30: Percent of households reported food had run out at some time during the previous 12 months, and months of adequate household food provisioning (MAHFP) by

background characteristics

Background characteristic % household food had run out during

past 12 months

Average MAHFP

% yet to acheive the target

No. of Households


1-3 32.5 10.6 11.9 174

4-6 20.4 11.0 8.5 407

≥ 7 14.0 9.9 17.8 50

Residence

Urban 4.8 7.1 40.6 70

Rural 24.7 11.2 6.4 561


No schooling 36.8 12.5 4.2 16

Primary 41.2 13.3 10.7 106

Secondary 23.5 11.7 2.7 213

Passed O’ Level 10.4 9.0 25.4 251

Higher 0.0 7.2 40.0 20


< 9,000 43.2 10.0 16.5 203

9,000 – 13,999 18.8 7.4 38.2 126

14,000 – 19,999 16.0 12.4 3.6 99

20,000 – 31,999 11.6 14.7 22.6 116

≥ 32,000 6.7 9.1 24.1 78

Wealth quintile

Poorest 49.5 17.9 49.3 56

Second 39.4 11.4 4.8 96

Middle 14.6 10.3 13.8 138

Fourth 16.1 9.1 24.4 184

Richest 8.1 10.2 14.8 157

Overall 23.3 10.8 10.2 631

46

Table A 31: Average number of times a household received food aid in the last 6 months, by

background characteristics

Characteristic

Type of food aid (mean no. of times per 6 month)

No. of household

s

Not

rec

eive

d fo

od a

ids

WFP

/GA

Sam

urdh

i

Food

Bas

ket

Scho

ol fe

edin

g

CSB

Thri

posh

a

Food

for

wor

k

Oth

er


1-3 70.8 0.0 4.0 6.0 0.0 0.0 1.8 0.0 6.0 169

4-6 73.5 6.0 3.8 4.7 4.0 0.0 1.4 0.0 1.0 389

≥ 7 72.1 0.0 4.3 0.0 20.0 0.0 0.0 6.0 0.0 43

Sector

Urban 81.0 0.0 3.0 0.0 0.0 0.0 1.0 0.0 0.0 42

Rural 72.0 6.0 3.9 5.3 9.3 0.0 1.5 6.0 4.3 559


< 9,000 61.9 0.0 3.7 6.0 6.0 0.0 1.4 0.0 4.3 190

9,000 – 13,999 69.1 0.0 3.6 0.0 0.0 0.0 1.5 0.0 0.0 81

14,000 – 19,999 73.6 0.0 5.2 4.0 0.0 0.0 1.5 6.0 0.0 106

20,000 – 31,999 85.5 0.0 3.6 0.0 11.0 0.0 1.2 0.0 0.0 146

≥ 32,000 83.3 6.0 3.3 0.0 0.0 0.0 1.0 0.0 0.0 60


Poorest 53.1 0.0 3.9 6.0 0.0 0.0 2.3 0.0 1.0 99

Second 66.0 0.0 3.5 2.0 2.0 0.0 1.5 0.0 6.0 100

Middle 72.1 0.0 4.5 6.0 13.0 0.0 1.3 0.0 6.0 123

Fourth 76.9 6.0 4.1 0.0 0.0 0.0 1.3 6.0 0.0 143

Richest 87.5 0.0 3.2 0.0 0.0 0.0 1.3 0.0 0.0 136

Overall 72.6 6.0 3.9 5.3 9.3 0.0 1.5 6.0 4.3 601

47

Table A 32: Percent of households with coping strategy adopted in the previous 30 days, with its frequency

Coping Strategy

% of households adopted strategy

Total households Never

Ever

Once in a while (1-2 per week)

Pretty often (3-6 per week)

Daily (>24 days)

Food-related coping strategy a. Relied on less preferred food 84.2 7.3 6.2 2.3 601

b. Borrowed food 89.9 5.8 4.0 0.3 601

c. Purchased food on credit 84.2 11.2 3.8 0.8 600

d. Consumed seeds held for next season 100.0 97.0 2.0 1.0 600

e. Reduced meal size 91.7 5.5 1.8 1.0 601

f. Reduced number of meals per day 93.7 4.3 1.2 0.8 599

g. Restricted consumption for adults 92.5 4.5 2.7 0.3 601

h. Sent children to live with relatives 98.7 0.8 0.3 0.2 600

i. Reduced expenditure on health and education 96.7 2.0 1.0 0.3 600

% of Households Total households

Non-food coping strategies No Yes

j. Sold livestock 99.5 0.5 599

k. Pawned jewellary 93.3 6.7 600

l. Sold agricultural tools, seeds 98.5 1.5 601

m. Sold other assets 99.2 0.8 600

n. Used savings 95.2 4.8 599

o. Borrowed money from relatives/neighbours 89.2 10.8 601

p. Took children out of school to earn income 99.8 0.2 600

48

Table A 33: Food-related coping strategies adopted during the 30 days preceding the survey, by background characteristics


Percent of households adopted strategy at least once during the preceding 30 days

No

of h

ouse

hold

s ad

opte

d co

ping

st

rate

gies

Rel

ied

on le

ss p

refe

rred

fo

od

Borr

owed

food

Purc

hase

d fo

od o

n cr

edit

Con

sum

ed s

eeds

hel

d fo

r ne

xt se

ason

Red

uced

mea

l siz

e

Red

uced

num

ber

of

mea

ls p

er d

ay

Res

tric

ted

cons

umpt

ion

for

adul

ts

Sent

chi

ldre

n to

live

w

ith r

elat

ives

Red

uced

exp

endi

ture

on

hea

lth a

nd

educ

atio

n


1-3 46 87.0 63.0 67.4 13.0 56.5 41.3 28.3 13.0 17.4

4-6 70 70.0 41.4 84.3 12.9 30.0 24.3 40.0 2.9 12.9

≥ 7 7 85.7 42.9 71.4 42.9 42.9 28.6 57.1 0.0 42.9

Sector

Urban 3 100.0 33.3 100.0 0.0 33.3 66.7 66.7 0.0 33.3

Rural 120 76.7 50.0 76.7 15.0 40.8 30.0 35.8 6.7 15.8


< 9,000 69 84.1 59.4 72.5 21.7 47.8 39.1 37.7 7.2 21.7

9,000 – 13,999 18 88.9 50.0 83.3 11.1 27.8 11.1 38.9 5.6 11.1

14,000 – 19,999 11 90.9 27.3 72.7 0.0 54.5 27.3 63.6 9.1 18.2

20,000 – 31,999 18 38.9 33.3 88.9 0.0 22.2 22.2 27.8 5.6 0.0

≥ 32,000 3 33.3 0.0 66.7 0.0 0.0 0.0 0.0 0.0 0.0

Wealth quintile

Poorest 37 86.5 56.8 73.0 16.2 48.6 43.2 27.0 13.5 27.0

Second 35 74.3 51.4 77.1 20.0 42.9 31.4 37.1 5.7 11.4

Middle 23 87.0 47.8 78.3 13.0 52.2 30.4 56.5 0.0 13.0

Fourth 18 72.2 55.6 83.3 11.1 22.2 16.7 38.9 5.6 16.7

Richest 10 40.0 10.0 80.0 0.0 10.0 10.0 20.0 0.0 0.0

Overall 123 77.2 49.6 77.2 14.6 40.7 30.9 36.6 6.5 16.3

49

Table A 34: Households taken loans and reasons for borrowing money, by background characteristics


Received loan Main reason for loan (% of the total received loan)

No %

Purc

hase

food

Med

ical

cos

t

Rep

air

of d

amag

ed

hous

e

Tra

nspo

rt

Rep

ay lo

an

supp

ort a

dditi

onal

m

embe

rs

Mar

riag

e

Inco

me

gene

ratio

n

Oth

er


1-3 31 18.5 22.6 3.2 9.7 3.2 12.9 0.0 0.0 25.8 22.6

4-6 97 25.3 11.2 4.1 15.3 0.0 5.1 0.0 0.0 31.6 32.7

≥ 7 12 27.9 9.1 9.1 36.4 9.1 0.0 0.0 0.0 18.2 18.2

Sector

Urban 4 9.5 25.0 0.0 0.0 50.0 0.0 0.0 0.0 25.0 0.0

Rural 136 24.6 13.2 4.4 16.2 0.0 6.6 0.0 0.0 29.4 30.1


< 9,000 50 27.0 21.6 5.9 17.6 0.0 3.9 0.0 0.0 25.5 25.5

9,000 – 13,999 22 27.2 9.1 4.5 0.0 0.0 9.1 0.0 0.0 31.8 45.5

14,000 – 19,999 24 22.6 12.5 0.0 8.3 8.3 12.5 0.0 0.0 29.2 29.2

20,000 – 31,999 34 23.4 8.8 5.9 20.6 0.0 5.9 0.0 0.0 29.4 29.4

≥ 32,000 9 15.0 0.0 0.0 37.5 0.0 0.0 0.0 0.0 50.0 12.5

Wealth quintile

Poorest 26 26.8 18.5 7.4 14.8 0.0 3.7 0.0 0.0 14.8 40.7

Second 27 27.3 29.6 3.7 14.8 0.0 14.8 0.0 0.0 25.9 11.1

Middle 26 21.5 7.7 7.7 11.5 0.0 3.8 0.0 0.0 26.9 42.3

Fourth 34 23.9 5.9 0.0 20.6 2.9 2.9 0.0 0.0 38.2 29.4

Richest 27 19.9 7.7 3.8 15.4 3.8 7.7 0.0 0.0 38.5 23.1

Overall 595 23.5 13.6 4.3 15.7 1.4 6.4 0.0 0.0 29.3 29.3

50

Table A 35: Household Food Consumption Adequacy Score (HFCAS) and prevalence of household food insecurity status, by background characteristics

Background

characteristic Mean (SD) HFCAS Score* HFCAS Score Category (%) No. of

households Poor Borderline Adequate No. of members in family

1-3 60.6 (13.4) 0.0 3.6 96.4 169

4-6 64.5 (12.0) 0.0 1.3 98.7 389

≥ 7 69.8 (11.2) 0.0 0.0 100.0 43

Residence

Urban 71.4 (13.3) 0.0 0.0 100.0 42

Rural 63.2 (12.4) 0.0 2.0 98.0 559

Religion of household Head

Buddhist 63.2 (12.3) 0.0 2.0 98.0 554

Hindu 51.0 (20.5) 0.0 0.0 100.0 2

Islam 73.0 (13.1) 0.0 0.0 100.0 35

Catholic and other Christian

76.8 (30.8) 0.0 0.0 100.0 2


No schooling 56.0 (12.8) 0.0 0.0 100.0 19

Primary 57.7 (12.5) 0.0 5.3 94.7 131

Secondary 64.1 (11.9) 0.0 1.4 98.6 218

Passed O’ Level 68.3 (11.2) 0.0 0.0 100.0 192

Higher 71.8 (8.8) 0.0 0.0 100.0 12


< 9,000 59.7 (12.7) 0.0 4.2 95.8 190

9,000 – 13,999 60.8 (11.6) 0.0 1.2 98.8 81

14,000 – 19,999 65.7 (12.2) 0.0 0.9 99.1 106

20,000 – 31,999 67.0 (11.3) 0.0 0.0 100.0 146

≥ 32,000 70.6 (12.1) 0.0 0.0 100.0 60

Wealth quintile

Poorest 56.3 (13.2) 0.0 8.1 91.9 99

Second 59.4 (12.4) 0.0 2.0 98.0 100

Middle 64.5 (12.5) 0.0 0.8 99.2 123

Fourth 65.7 (10.4) 0.0 0.0 100.0 143

Richest 69.7 (10.8) 0.0 0.0 100.0 136

Overall 63.8 (12.6) 0.0 1.8 98.2 601

51

Table A 36: Distribution of households by food security Levels

Food Consumption Food Access (Percent expenditure on food)

Poor (0-21) Borderline (21.01 – 35) Adequate (> 35.01)

Poor ( > 90 %) 0 (0.0) 1 (0.0) 30 (13.2)

Average (75-90 %) 0 (0.0) 0 (0.0) 103 (45.4)

Good (<75 %) 0 (0.0) 0 (0.0) 93 (41.0)

Table A 37: Distribution of households by food security levels by background

characteristics


Food Security Level

No. of households Food

Secure (%) Moderately Food

Secure (%) Food Insecure

(%)


1-3 73.3 23.3 3.3 30

4-6 88.0 12.0 0.0 166

≥ 7 90.3 9.7 0.0 31

Sector

Urban 100.0 0.0 0.0 14

Rural 85.4 14.1 0.5 213


No schooling 33.3 66.7 0.0 3

Primary 69.2 30.8 0.0 26

Secondary 82.5 16.3 1.3 80

Passed O’ Level 93.3 6.7 0.0 104

Higher 100.0 0.0 0.0 2


< 9,000 74.6 23.8 1.6 63

9,000 – 13,999 81.5 18.5 0.0 27

14,000 – 19,999 91.1 8.9 0.0 45

20,000 – 31,999 95.7 4.3 0.0 69

≥ 32,000 100.0 0.0 0.0 19

Wealth quintile

Poorest 59.5 38.1 2.4 42

Second 80.0 20.0 0.0 25

Middle 93.3 6.7 0.0 45

Fourth 93.6 6.4 0.0 47

Richest 95.6 4.4 0.0 68

Overall 86.3 13.2 0.4 227

52

ANNEX II The steps followed in estimating levels of food insecurity were as follows:

Step1: Calculate a household food consumption adequacy score (HFCAS) based on food groups consumed during 1 week prior to survey, grouped into 3 categories as described in footnote5. Step 2: Estimating the expenditure on food as a percentage of the total household expenditure, and categorizing the households into 3 groups indicating different levels of food access (<75 percent - good; 75t o 90 percent - average and >90 percent - poor food access). Step 3: Cross-tabulation between food consumption categories and food access categories.

Food insecurity levels were assessed in accordance with the classification given in Figure 2.

Figure 2: Assessment of food insecurity levels

Food consumption Poor Borderline Adequate

Food access

Poor Severely food insecure Severely food insecure Moderately food insecure

Average Severely food insecure Moderately food insecure Food Secure

Good Moderately food insecure Food Secure Food Secure

5 Eight food groups were used to calculate the Food consumption adequacy score.

Food group Food times 1. Staple foods (starches) Rice, bread / chapti /roti 2. Pulses/legumes Pulses 3. Vegetables vegetables (including leaves) 4. Fruits fruits 5. Animal protein Fish, meat (beef, pork, chicken), eggs 6. Sugar sugar/ jaggary 7. Dairy products Curd, milk (liquid or powder) 8. Oil/fats palm oil, vegetable oil, fats, coconut products (dried copra)

The number of days the food items were consumed during the previous week was summed for the food items in each of the 8 food groups. If the total sum of the number of days of the separate items in a food group was higher than 7 days, the sum is converted to 7. Thus, the maximum score for each food group is 7 days. The food score of each household is calculated as follows: Simple food score = 2 * staple + 3 * pulses + 1 * vegetables + 1* fruit + 4 * animal protein + 0.5 * sugar + 3 * dairy + 0.5 * oil The households were grouped according to their scores by applying the standard cut-offs as follows:

Poor food consumption: simple food score is 0 – 21 Borderline food consumption: simple food score is 21.01 – 35 Adequate food consumption: simple food score is 35.01 and higher

Documents

Nutrition and Food Security Assessment in Sri Lanka - 2009